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Persson A, Koivula T, Jacobsson S, Stenmark B. Diverse proinflammatory response in pharyngeal epithelial cells upon interaction with Neisseria meningitidis carriage and invasive isolates. BMC Infect Dis 2024; 24:286. [PMID: 38443838 PMCID: PMC10916014 DOI: 10.1186/s12879-024-09186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/01/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. RESULTS The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1β and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. CONCLUSION Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.
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Affiliation(s)
- Alexander Persson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Therese Koivula
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Susanne Jacobsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bianca Stenmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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2
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Eames KTD, Tang ML, Hill EM, Tildesley MJ, Read JM, Keeling MJ, Gog JR. Coughs, colds and "freshers' flu" survey in the University of Cambridge, 2007-2008. Epidemics 2023; 42:100659. [PMID: 36758342 DOI: 10.1016/j.epidem.2022.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/06/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Universities provide many opportunities for the spread of infectious respiratory illnesses. Students are brought together into close proximity from all across the world and interact with one another in their accommodation, through lectures and small group teaching and in social settings. The COVID-19 global pandemic has highlighted the need for sufficient data to help determine which of these factors are important for infectious disease transmission in universities and hence control university morbidity as well as community spillover. We describe the data from a previously unpublished self-reported university survey of coughs, colds and influenza-like symptoms collected in Cambridge, UK, during winter 2007-2008. The online survey collected information on symptoms and socio-demographic, academic and lifestyle factors. There were 1076 responses, 97% from University of Cambridge students (5.7% of the total university student population), 3% from staff and <1% from other participants, reporting onset of symptoms between September 2007 and March 2008. Undergraduates are seen to report symptoms earlier in the term than postgraduates; differences in reported date of symptoms are also seen between subjects and accommodation types, although these descriptive results could be confounded by survey biases. Despite the historical and exploratory nature of the study, this is one of few recent detailed datasets of influenza-like infection in a university context and is especially valuable to share now to improve understanding of potential transmission dynamics in universities during the current COVID-19 pandemic.
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Affiliation(s)
- Ken T D Eames
- Department of Applied Mathematics and Theoretical Physics, Centre for Mathematical Sciences, University of Cambridge, Cambridge, CB3 0WA, UK
| | - Maria L Tang
- Department of Applied Mathematics and Theoretical Physics, Centre for Mathematical Sciences, University of Cambridge, Cambridge, CB3 0WA, UK; Joint UNIversities Pandemic and Epidemiological Research, UK(1).
| | - Edward M Hill
- Joint UNIversities Pandemic and Epidemiological Research, UK(1); The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael J Tildesley
- Joint UNIversities Pandemic and Epidemiological Research, UK(1); The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Jonathan M Read
- Joint UNIversities Pandemic and Epidemiological Research, UK(1); Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Matt J Keeling
- Joint UNIversities Pandemic and Epidemiological Research, UK(1); The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Julia R Gog
- Department of Applied Mathematics and Theoretical Physics, Centre for Mathematical Sciences, University of Cambridge, Cambridge, CB3 0WA, UK; Joint UNIversities Pandemic and Epidemiological Research, UK(1).
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3
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Prevalence and persistence of Neisseria meningitidis carriage in Swedish university students. Epidemiol Infect 2023; 151:e25. [PMID: 36775828 PMCID: PMC9990396 DOI: 10.1017/s0950268823000018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
The bacterium Neisseria meningitidis causes life-threatening disease worldwide, typically with a clinical presentation of sepsis or meningitis, but can be carried asymptomatically as part of the normal human oropharyngeal microbiota. The aim of this study was to examine N. meningitidis carriage with regard to prevalence, risk factors for carriage, distribution of meningococcal lineages and persistence of meningococcal carriage. Throat samples and data from a self-reported questionnaire were obtained from 2744 university students (median age: 23 years) at a university in Sweden on four occasions during a 12-month period. Meningococcal isolates were characterised using whole-genome sequencing. The carriage rate among the students was 9.1% (319/3488; 95% CI 8.2-10.1). Factors associated with higher carriage rate were age ≤22 years, previous tonsillectomy, cigarette smoking, drinking alcohol and attending parties, pubs and clubs. Female gender and sharing a household with children aged 0-9 years were associated with lower carriage. The most frequent genogroups were capsule null locus (cnl), group B and group Y and the most commonly identified clonal complexes (cc) were cc198 and cc23. Persistent carriage with the same meningococcal strain for 12 months was observed in two students. Follow-up times exceeding 12 months are recommended for future studies investigating long-term carriage of N. meningitidis.
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Marshall GS, Fergie J, Presa J, Peyrani P. Rationale for the Development of a Pentavalent Meningococcal Vaccine: A US-Focused Review. Infect Dis Ther 2022; 11:937-951. [PMID: 35357651 PMCID: PMC8969818 DOI: 10.1007/s40121-022-00609-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/14/2022] [Indexed: 12/04/2022] Open
Abstract
While invasive meningococcal disease (IMD) is uncommon, it can result in serious sequelae and even death. In 2018 in the United States, the incidence of IMD per 100,000 people was 0.03 among adolescents 11−15 years of age, 0.10 among persons 16−23 years of age, and 0.83 among infants < 1 year of age. Serogroup B accounted for 86%, 62%, and 66% of cases, respectively, in those age groups. Currently, routine meningococcal vaccination covering serogroups ACWY (MenACWY) is recommended in the United States for all adolescents at 11−12 years of age, with a booster dose at 16 years of age, whereas a meningococcal serogroup B (MenB) vaccine series is recommended for persons 16−23 years of age under the shared clinical decision-making paradigm. The MenACWY vaccination program in adolescents has been successful in reducing disease burden, but does not prevent disease caused by serogroup B, which accounts for more than half of IMD cases. There are currently no approved vaccines that cover all of the most common disease-causing meningococcal serogroups, which are A, B, C, W, and Y. A pentavalent MenABCWY vaccine that is constituted from 2 licensed meningococcal vaccines—MenB-FHbp and MenACWY-TT—is being investigated in healthy persons ≥ 10–25 years of age. The addition of a MenABCWY vaccine is the next natural step in the incremental meningococcal immunization program in the United States to improve protection against the most common serogroup causing IMD, with no increase in the number of immunizations needed. With high uptake, routine use of MenABCWY could reduce IMD cases and associated mortality, the rate of long-term physical and psychosocial sequelae in survivors, and costs associated with controlling outbreaks, particularly on college campuses. A MenABCWY vaccine would also reduce the number of injections required for adolescents, potentially improving compliance.
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Affiliation(s)
- Gary S. Marshall
- Division of Pediatric Infectious Diseases, Norton Children’s and University of Louisville School of Medicine, 571 S. Floyd St, Suite 321, Louisville, KY 40202 USA
| | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, TX USA
| | - Jessica Presa
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA USA
| | - Paula Peyrani
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA USA
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Facchetti A, Wheeler JX, Vipond C, Whiting G, Lavender H, Feavers IM, Maiden MCJ, Maharjan S. Factor H binding protein (fHbp)-mediated differential complement resistance of a serogroup C Neisseria meningitidis isolate from cerebrospinal fluid of a patient with invasive meningococcal disease. Access Microbiol 2021; 3:000255. [PMID: 34712903 PMCID: PMC8549389 DOI: 10.1099/acmi.0.000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/03/2021] [Indexed: 11/01/2022] Open
Abstract
During an outbreak of invasive meningococcal disease (IMD) at the University of Southampton, UK, in 1997, two Neisseria meningitidis serogroup C isolates were retrieved from a student ('Case'), who died of IMD, and a close contact ('Carrier') who, after mouth-to-mouth resuscitation on the deceased, did not contract the disease. Genomic comparison of the isolates demonstrated extensive nucleotide sequence identity, with differences identified in eight genes. Here, comparative proteomics was used to measure differential protein expression between the isolates and investigate whether the differences contributed to the clinical outcomes. A total of six proteins were differentially expressed: four proteins (methylcitrate synthase, PrpC; hypothetical integral membrane protein, Imp; fructose-1,6-bisphosphate aldolase, Fba; aldehyde dehydrogenase A, AldA) were upregulated in the Case isolate, while one protein (Type IV pilus-associated protein, PilC2) was downregulated. Peptides for factor H binding protein (fHbp), a major virulence factor and antigenic protein, were only detected in the Case, with a single base deletion (ΔT366) in the Carrier fHbp causing lack of its expression. Expression of fHbp resulted in an increased resistance of the Case isolate to complement-mediated killing in serum. Complementation of fHbp expression in the Carrier increased its serum resistance by approximately 8-fold. Moreover, a higher serum bactericidal antibody titre was seen for the Case isolate when using sera from mice immunized with Bexsero (GlaxoSmithKline), a vaccine containing fHbp as an antigenic component. This study highlights the role of fHbp in the differential complement resistance of the Case and the Carrier isolates. Expression of fHbp in the Case resulted in its increased survival in serum, possibly leading to active proliferation of the bacteria in blood and death of the student through IMD. Moreover, enhanced killing of the Case isolate by sera raised against an fHbp-containing vaccine, Bexsero, underlines the role and importance of fHbp in infection and immunity.
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Affiliation(s)
- Alessandra Facchetti
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Jun X Wheeler
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Caroline Vipond
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Gail Whiting
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Hayley Lavender
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Ian M Feavers
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Martin C J Maiden
- Department of Zoology, Peter Medawar Building, University of Oxford, South Parks Road, Oxford, OX1 3SY, UK
| | - Sunil Maharjan
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
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6
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Tzeng YL, Stephens DS. A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control. Microorganisms 2021; 9:microorganisms9030519. [PMID: 33802567 PMCID: PMC7999845 DOI: 10.3390/microorganisms9030519] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis, carried in the human nasopharynx asymptomatically by ~10% of the population, remains a leading cause of meningitis and rapidly fatal sepsis, usually in otherwise healthy individuals. The epidemiology of invasive meningococcal disease (IMD) varies substantially by geography and over time and is now influenced by meningococcal vaccines and in 2020–2021 by COVID-19 pandemic containment measures. While 12 capsular groups, defined by capsular polysaccharide structures, can be expressed by N. meningitidis, groups A, B, and C historically caused most IMD. However, the use of mono-, bi-, and quadrivalent-polysaccharide-conjugate vaccines, the introduction of protein-based vaccines for group B, natural disease fluctuations, new drugs (e.g., eculizumab) that increase meningococcal susceptibility, changing transmission dynamics and meningococcal evolution are impacting the incidence of the capsular groups causing IMD. While the ability to spread and cause illness vary considerably, capsular groups W, X, and Y now cause significant IMD. In addition, group E and nongroupable meningococci have appeared as a cause of invasive disease, and a nongroupable N. meningitidis pathotype of the hypervirulent clonal complex 11 is causing sexually transmitted urethritis cases and outbreaks. Carriage and IMD of the previously “minor” N. meningitidis are reviewed and the need for polyvalent meningococcal vaccines emphasized.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence: ; Tel.: +404-727-8357
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7
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Waterfield T, Lyttle MD, McKenna J, Maney JA, Roland D, Corr M, Woolfall K, Patenall B, Shields M, Fairley D. Loop-mediated isothermal amplification for the early diagnosis of invasive meningococcal disease in children. Arch Dis Child 2020; 105:1151-1156. [PMID: 32586928 DOI: 10.1136/archdischild-2020-319139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rapid molecular diagnostic testing has the potential to improve the early recognition of meningococcal disease (MD). The aim of this study was to report on the diagnostic test accuracy of point-of-care loop-mediated isothermal amplification (LAMP) in the diagnosis of MD. DESIGN Data were collected prospectively from three UK emergency departments (ED) between November 2017 and June 2019. Consecutive children under 18 years of age attending the ED with features of MD were eligible for inclusion. The meningococcal LAMP test (index test) was performed on a dry swab of the child's oropharynx. Reference standard testing was the confirmation of invasive MD defined as positive N. meningitidis culture or PCR result from a sterile body site (blood or cerebrospinal fluid). RESULTS There were 260 children included in the final analysis. The median age was 2 years 11 months and 169 (65%) children were aged 5 years or younger. The LAMP test was negative in 246 children and positive in 14 children. Of the 14 children with positive LAMP tests, there were five cases of invasive MD. Of the 246 children with negative LAMP tests, there were no cases of invasive MD. The sensitivity of LAMP testing was 1.00 and the specificity was 0.97. The negative and positive predictive values were 1.00 and 0.36, respectively. The positive likelihood ratio was 28.3. DISCUSSION Non-invasive LAMP testing using oropharyngeal swabs provided an accurate fast and minimally invasive mechanism for predicting invasive MD in this study. TRIAL REGISTRATION NUMBER NCT03378258.
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Affiliation(s)
- Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK .,Emergency Department, Royal Belfast Children's Hospital, Belfast, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James McKenna
- Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Julie-Ann Maney
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK
| | - Michael Corr
- Belfast Health and Social Care Trust, Belfast, UK
| | - Kerry Woolfall
- Institute of Psychology, University of Liverpool, Liverpool, UK
| | | | - Michael Shields
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.,The Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Derek Fairley
- The Royal Belfast Hospital for Sick Children, Belfast, UK
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8
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Srivastava A, Dempsey A, Galitsky A, Fahimi M, Huang L. Parental awareness and utilization of meningococcal serogroup B vaccines in the United States. BMC Public Health 2020; 20:1109. [PMID: 32664872 PMCID: PMC7362432 DOI: 10.1186/s12889-020-09181-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Meningococcal serogroup B (MenB) is the most common cause of invasive meningococcal disease (IMD) in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends vaccination of healthy adolescents against MenB based on shared clinical decision-making (Category B recommendation). This survey assessed factors associated with MenB vaccine awareness, utilization, and interest among parents/guardians of US adolescents. Methods Survey participants were identified in 2016 through KnowledgePanel®, an online random sample of US households; population-based weighting methodology was used to ensure data reflected a demographically representative population sample. Adults with ≥1 dependent aged 16–19 years were eligible and completed an online questionnaire. Respondents were grouped in terms of MenB vaccination of their child as: 1) vaccinated, 2) intending to vaccinate, 3) MenB vaccine-unaware, or 4) vaccine-aware but not intending to vaccinate. Univariate and multivariate analyses were used to identify factors influencing MenB vaccine awareness and utilization; univariate analyses used the weighted proportion of each group or weighted means, and multivariate analyses used logistic regression models based on the weighted study sample of each group. Results Six hundred nineteen parents/guardians participated, corresponding to 26,266,700 members of the US population after weighting. MenB vaccine awareness was significantly associated with parent race and sex. Specifically, 57% of parents were unaware of MenB vaccines, and there was significantly higher lack of awareness among males and those of Hispanic or non-White ethnicity. In addition, 36% of unaware parents/guardians were interested in and seeking MenB vaccine information from their healthcare provider (HCP), and there was higher interest among parents of Hispanic ethnicity. ‘Vaccinated/intending to vaccinate’ versus ‘not intending to vaccinate’ and ‘vaccinated’ versus ‘intending to vaccinate’ were both strongly associated with whether an HCP had recommended vaccination (odds ratios, 4.81 [95% CI 2.46, 9.35] and 5.66 [95% CI 2.46, 12.87], respectively). Conclusions Racial and socioeconomic disparities exist in the awareness and utilization of MenB vaccines among parents/guardians of US adolescents. HCP discussion and recommendation are critical catalysts for MenB vaccination and underscore the need to accurately interpret and implement the shared clinical decision-making (Category B) recommendation.
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Affiliation(s)
- Amit Srivastava
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
| | | | | | | | - Liping Huang
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc,, Collegeville, PA, USA
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Jones S, Cortina Borja M, Bedford H. "I think meningitis is a virus, while septicaemia might be caused by bacteria." A study of vaccination views, disease awareness and MenACWY and MMR uptake among freshers at a London university. Int J Adolesc Med Health 2020; 34:77-86. [PMID: 32543452 DOI: 10.1515/ijamh-2019-0254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/13/2020] [Indexed: 11/15/2022]
Abstract
Background University students are at particular risk of invasive meningococcal disease (IMD). Group W, an aggressive strain, is increasing in prevalence and the high case-fatality rate is concerning. Adolescents have been offered the MenACWY vaccine since 2015. National uptake has been low, leaving students vulnerable to infection. Objectives To investigate MenACWY uptake, knowledge of IMD and attitudes towards vaccination among UCL first-year students. Methods A mixed methods approach was used, involving a questionnaire (n=144) and follow-up interviews (n=13). Students were asked for demographic details and questions including vaccination status, awareness of the vaccine, other vaccination history and knowledge of IMD, which was assessed through true/false/unsure statements. Interviews explored these issues in more detail as well as their suggestions for making vaccination more accessible for students. Results MenACWY uptake was 84%, with more socioeconomically disadvantaged students being less likely to be vaccinated (aOR=0.117, p=0.006). Most students thought vaccines were safe and important. Students with above average knowledge were more likely to be vaccinated (OR=3.057, p=0.019). Vaccination views were positive and knowledge level was moderate to high. Reasons for non-vaccination included illness, laziness, forgetfulness and difficulty with GP access. Of concern, many students believed that the vaccine prevents any cause of meningitis. Conclusion High vaccine uptake is essential to protect students. Uptake at University College London is higher than at other universities in previous studies. This research highlights several areas requiring further study and has implications for university vaccination policy.
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Affiliation(s)
| | | | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, London, UK
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10
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Alderfer J, Isturiz RE, Srivastava A. Lessons from mass vaccination response to meningococcal B outbreaks at US universities. Postgrad Med 2020; 132:614-623. [DOI: 10.1080/00325481.2020.1766265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Justine Alderfer
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Raul E. Isturiz
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Amit Srivastava
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
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11
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Stenmark B, Harrison OB, Eriksson L, Anton BP, Fomenkov A, Roberts RJ, Tooming-Klunderud A, Bratcher HB, Bray JE, Thulin-Hedberg S, Maiden MCJ, Mölling P. Complete genome and methylome analysis of Neisseria meningitidis associated with increased serogroup Y disease. Sci Rep 2020; 10:3644. [PMID: 32108139 PMCID: PMC7046676 DOI: 10.1038/s41598-020-59509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Invasive meningococcal disease (IMD) due to serogroup Y Neisseria meningitidis emerged in Europe during the 2000s. Draft genomes of serogroup Y isolates in Sweden revealed that although the population structure of these isolates was similar to other serogroup Y isolates internationally, a distinct strain (YI) and more specifically a sublineage (1) of this strain was responsible for the increase of serogroup Y IMD in Sweden. We performed single molecule real-time (SMRT) sequencing on eight serogroup Y isolates from different sublineages to unravel the genetic and epigenetic factors delineating them, in order to understand the serogroup Y emergence. Extensive comparisons between the serogroup Y sublineages of all coding sequences, complex genomic regions, intergenic regions, and methylation motifs revealed small point mutations in genes mainly encoding hypothetical and metabolic proteins, and non-synonymous variants in genes involved in adhesion, iron acquisition, and endotoxin production. The methylation motif CACNNNNNTAC was only found in isolates of sublineage 2. Only seven genes were putatively differentially expressed, and another two genes encoding hypothetical proteins were only present in sublineage 2. These data suggest that the serogroup Y IMD increase in Sweden was most probably due to small changes in genes important for colonization and transmission.
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Affiliation(s)
- Bianca Stenmark
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Odile B Harrison
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Lorraine Eriksson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | - Ave Tooming-Klunderud
- Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, Oslo, Norway
| | - Holly B Bratcher
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - James E Bray
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Sara Thulin-Hedberg
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Paula Mölling
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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12
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Ambrosio L, Neri A, Fazio C, Rossolini GM, Vacca P, Riccobono E, Voller F, Miglietta A, Stefanelli P. Genomic analysis of Neisseria meningitidis carriage isolates during an outbreak of serogroup C clonal complex 11, Tuscany, Italy. PLoS One 2019; 14:e0217500. [PMID: 31136624 PMCID: PMC6538176 DOI: 10.1371/journal.pone.0217500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background In 2015–2016, a cross-sectional carriage survey was performed in Tuscany Region, Italy, during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C clonal complex 11 (MenC:cc11). This study aims to evaluate the genomic profile of meningococcal carriage isolates collected during the survey. Methods Whole-genome sequencing (WGS) was performed using Illumina MiSeq on 85 cultivated meningococcal carriage isolates received at the Dept. of Infectious Disease, National Institute of Health (Istituto Superiore di Sanità, ISS), as National Reference Laboratory (NRL) for Invasive Meningococcal Disease (IMD). De novo assembled genomes were scanned by the BIGSdb platform to assign: the genotypic profiles, the cgMLST, the vaccine antigen variants and allele types of antimicrobial resistance associated genes, together with denitrification pathway loci. Results Capsule null and non-groupable meningococci accounted for 52.9% and 10.6%, respectively. Among the remaining carriage isolates, serogroup B was the predominant (71.0%). Serogroup C meningococci were culture negative and unavailable for WGS. Overall, 64 genotypic profiles were identified and, based on cgMLST, isolates clustered according to clonal complexes. Eight isolates (9.4%) harbored at least one gene encoding a 4CMenB vaccine antigen. Mutated penA alleles were found in more than 82%. Finally, complete aniA and norB coding sequences were detected among 71.8% of carriage isolates. Conclusions Meningococcal carriage isolates collected during the MenC:cc11 outbreak were characterized by an extensive genetic diversity. The lack of outbreak-related isolates among carriage might be attributable to the high transmissibility with low duration of colonization of MenC:cc11 meningococci.
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Affiliation(s)
- Luigina Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Alessandro Miglietta
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- * E-mail:
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Waterfield T, Fairley D, Blackwood B, McKenna J, Shields MD. A systematic review of the diagnostic accuracy of Loop-mediated-isothermal AMPlification (LAMP) in the diagnosis of invasive meningococcal disease in children. BMC Pediatr 2019; 19:49. [PMID: 30732581 PMCID: PMC6366060 DOI: 10.1186/s12887-019-1403-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early recognition of meningococcal disease in children is vital. During the prodrome however, meningococcal infection presents similarly to many self-limiting viral infections. This mandates a cautious approach with many children receiving unnecessary broad-spectrum parenteral antibiotics. Advances in nucleic acid amplification techniques mean that it is now possible to test for Neisseria meningitidis DNA using Loop-mediated-isothermal AMPlification (LAMP). This technique is quicker than traditional PCR techniques and can be performed using simple equipment. METHODS Prior to performing this systematic review, a protocol was developed adhering to PRISMA P standards and underwent full external peer review. This systematic review was registered with PROSPERO (CRD42017078026). The index test assessed was LAMP for Neisseria meningitidis and the reference standard was culture or qPCR of a sterile site detecting Neisseria meningitidis. RESULTS We identified 95 records in total: 94 records from the electronic databases and 1 additional study from the grey literature. After removal of duplicates, 36 studies were screened, and 31 studies excluded based on the title/abstract. Five full text studies underwent full text review and three studies, including 2243 tests on 1989 patients aged between 7 days and 18 years were included in the final systematic review. In all studies the LAMP assay and qPCR primers were directed against the ctrA region of the Neisseria meningitidis bacteria. The diagnostic accuracy of LAMP testing for invasive meningococcal disease was reported as high (sensitivity 0.84-1.0 and specificity 0.94-1.0) in all studies irrespective of the sample tested (CSF, Blood, Swab). CONCLUSIONS We included three studies with 2243 tests on 1989 patients using CSF, blood samples or naso/oropharyngeal swabs. The studies were all of a high quality and deemed at low risk of bias. Results show that LAMP testing on blood and CSF was highly accurate when compared to qPCR/culture. LAMP testing for Neisseria meningitidis is fast and highly accurate and therefore has the potential to be used to rapidly rule in/out meningococcal disease in children. Given the life-threatening nature of meningococcal infection further research is required to demonstrate the safety and efficacy of using LAMP testing for Neisseria meningitidis as a rule in/out test. TRIAL REGISTRATION This systematic review was registered prospectively with PROSPERO on the 29/11/2017 (CRD42017078026).
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Affiliation(s)
- Thomas Waterfield
- Centre for Experimental Medicine, Queen's University Belfast, Wellcome Wolfson Institute of Experimental Medicine, 97 Lisburn Road, Belfast, BT9 7AE, UK.
| | | | - Bronagh Blackwood
- Centre for Experimental Medicine, Queen's University Belfast, Wellcome Wolfson Institute of Experimental Medicine, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | | | - Michael D Shields
- Centre for Experimental Medicine, Queen's University Belfast, Wellcome Wolfson Institute of Experimental Medicine, 97 Lisburn Road, Belfast, BT9 7AE, UK
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14
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McMillan M, Walters L, Mark T, Lawrence A, Leong LEX, Sullivan T, Rogers GB, Andrews RM, Marshall HS. B Part of It study: a longitudinal study to assess carriage of Neisseria meningitidis in first year university students in South Australia. Hum Vaccin Immunother 2019; 15:987-994. [PMID: 30513251 PMCID: PMC6605849 DOI: 10.1080/21645515.2018.1551672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives:N. meningitidis carriage in Australia is poorly understood. This study aimed to estimate prevalence and risk factors for carriage of N. meningitidis in South Australian university students. We also sought to identify whether delayed freezing of oropharyngeal samples altered PCR positivity, cycle threshold, or culture positivity. Methods: Oropharyngeal swabs were taken from first year university students and repeated after 3 months, with risk factor questionnaires completed at both visits. Specimens were subjected to real-time PCR screening for the presence of specific meningococcal DNA. Results: The study enrolled 421 individuals, 259 returned at 3 months. At baseline, 56% of participants were female and 1.9% smokers. Carriage of N. meningitidis at baseline was 6.2% (95% CI, [4.2%, 8.9%]). Visiting a bar more than once a week (OR 9.07; [2.44, 33.72]) and intimate kissing (OR 4.37; [1.45, 13.14]) were associated with increased carriage. After imputing missing data, the point estimate for carriage at 3 months was 8.6% compared to 6.2% at baseline (OR 1.42; 0.91 to 2.20). Recovery of N. meningitidis on selective agar was significantly reduced in cryovials frozen at 48 hours compared to 6 hours (24/26, 92.3% vs. 14/26, 53.9%, p = 0.002). Conclusion: Attending bars and engaging in intimate kissing is associated with oropharyngeal carriage in South Australian university students. Adolescent meningococcal vaccine programs should be implemented at school, prior to increased attendance at bars, intimate contact, and carriage acquisition. Delaying freezing of oropharyngeal specimens longer than 16 hours reduces yield of N. meningitidis by culture but not PCR detection.
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Affiliation(s)
- Mark McMillan
- a Vaccinology and Immunology Research Trials Unit , Women's and Children's Health Network , Adelaide , SA , Australia.,b Robinson Research Institute and Adelaide Medical School , The University of Adelaide , Adelaide , SA , Australia
| | - Luke Walters
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Turra Mark
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Andrew Lawrence
- c Microbiology and Infectious Diseases Directorate , SA Pathology , Adelaide , SA , Australia
| | - Lex E X Leong
- d South Australian Health & Medical Research Institute (SAHMRI) , Adelaide , SA , Australia
| | - Thomas Sullivan
- e School of Public Health , The University of Adelaide , Adelaide , SA , Australia
| | - Geraint B Rogers
- d South Australian Health & Medical Research Institute (SAHMRI) , Adelaide , SA , Australia
| | - Ross M Andrews
- f Menzies School of Health Research , Charles Darwin University , Darwin , Northern Territory , Australia.,g National Centre for Epidemiology & Population Health , Australian National University , Canberra , Australian Capital Territory , Australia
| | - Helen S Marshall
- a Vaccinology and Immunology Research Trials Unit , Women's and Children's Health Network , Adelaide , SA , Australia.,b Robinson Research Institute and Adelaide Medical School , The University of Adelaide , Adelaide , SA , Australia
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15
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Meningococcal carriage in high-risk settings: A systematic review. Int J Infect Dis 2018; 73:109-117. [DOI: 10.1016/j.ijid.2018.05.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
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Balmer P, Burman C, Serra L, York LJ. Impact of meningococcal vaccination on carriage and disease transmission: A review of the literature. Hum Vaccin Immunother 2018; 14:1118-1130. [PMID: 29565712 PMCID: PMC5989891 DOI: 10.1080/21645515.2018.1454570] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 12/28/2022] Open
Abstract
Colonization of the human nasopharyngeal tract by the bacterium Neisseria meningitidis is usually asymptomatic, but life-threatening meningococcal disease with a clinical presentation of meningitis, septicemia, or more rarely, gastrointestinal symptoms, can develop. Invasive meningococcal disease (IMD) can be fatal within 24 hours, but IMD is vaccine-preventable. Vaccines used to protect against IMD caused by 5 of the 6 most common serogroups (A, B, C, W, and Y) may also influence carriage prevalence in vaccinated individuals. Lower carriage among vaccinated people may reduce transmission to nonvaccinated individuals to provide herd protection against IMD. This article reviews observational and clinical studies examining effects of vaccination on N. meningitidis carriage prevalence in the context of mass vaccination campaigns and routine immunization programs. Challenges associated with carriage studies are presented alongside considerations for design of future studies to assess the impact of vaccination on carriage.
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Affiliation(s)
- Paul Balmer
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Cynthia Burman
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Lidia Serra
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
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Oldfield NJ, Cayrou C, AlJannat MAK, Al-Rubaiawi AAA, Green LR, Dada S, Steels OD, Stirrup C, Wanford J, Atwah BAY, Bayliss CD, Turner DPJ. Rise in Group W Meningococcal Carriage in University Students, United Kingdom. Emerg Infect Dis 2018; 23:1009-1011. [PMID: 28518025 PMCID: PMC5443439 DOI: 10.3201/eid2306.161768] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
MenACWY conjugate vaccination was recently introduced in the United Kingdom for adolescents and young adults to reduce disease from infection by Neisseria meningitidis group W. We conducted a cross-sectional meningococcal carriage study in first-year UK university students. Despite 71% MenACWY vaccine coverage, carriage of group W increased substantially.
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18
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McNamara LA, Thomas JD, MacNeil J, Chang HY, Day M, Fisher E, Martin S, Poissant T, Schmink SE, Steward-Clark E, Jenkins LT, Wang X, Acosta A. Meningococcal Carriage Following a Vaccination Campaign With MenB-4C and MenB-FHbp in Response to a University Serogroup B Meningococcal Disease Outbreak-Oregon, 2015-2016. J Infect Dis 2017; 216:1130-1140. [PMID: 28968661 DOI: 10.1093/infdis/jix446] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background Limited data exist on the impact of the serogroup B meningococcal (MenB) vaccines MenB-FHbp and MenB-4C on meningococcal carriage and herd protection. We therefore assessed meningococcal carriage following a MenB vaccination campaign in response to a university serogroup B meningococcal disease outbreak in 2015. Methods A convenience sample of students recommended for vaccination provided oropharyngeal swab specimens and completed questionnaires during 4 carriage surveys over 11 months. Isolates were tested by real-time polymerase chain reaction analysis, slide agglutination, and whole-genome sequencing. Vaccination history was verified via university records and the state immunization registry. Results A total of 4225 oropharyngeal swab specimens from 3802 unique participants were analyzed. Total meningococcal and genotypically serogroup B carriage prevalence among sampled students were stable, at 11%-17% and 1.2%-2.4% during each round, respectively; no participants carried the outbreak strain. Neither 1-3 doses of MenB-FHbp nor 1-2 doses of MenB-4C was associated with decreased total or serogroup B carriage prevalence. Conclusions While few participants completed the full MenB vaccination series, limiting analytic power, these data suggest that MenB-FHbp and MenB-4C do not have a large, rapid impact on meningococcal carriage and are unlikely to provide herd protection in the context of an outbreak response.
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Affiliation(s)
- Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Jennifer Dolan Thomas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Jessica MacNeil
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - How Yi Chang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Emily Fisher
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oregon Health Authority, Portland
| | - Stacey Martin
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Susanna E Schmink
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Evelene Steward-Clark
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Laurel T Jenkins
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Anna Acosta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
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19
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Pavli A, Katerelos P, Maltezou HC. Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0016/ijamh-2017-0016.xml. [PMID: 28598805 DOI: 10.1515/ijamh-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/22/2017] [Indexed: 11/15/2022]
Abstract
Objective Students living in dormitories are at increased risk for meningococcal disease. Our aim was to evaluate Greek students planning to study abroad about their level of meningococcal disease awareness and attitudes and practices towards meningococcal vaccination. Methods We studied 231 Greek ERASMUS students using a questionnaire. Results Students had a mean number of 4.1 correct answers out of six questions. In particular 66.5% 79.3%, 72.3% and 82.3% of them answered correctly about the etiology, transmission, epidemiology and treatment of meningococcal disease, respectively. Only 23.4% were vaccinated, whereas 14.7% were planning to do so in the near future. Students who answered correctly ≥5 questions were more likely to be male, vaccinated against meningococcal meningitis and science students. Conclusion We found an overall good level of knowledge about meningococcal disease among Greek students planning to study or already studying abroad. Knowledge about meningococcal disease was associated with vaccine uptake. However, vaccination rate against meningococcal disease was low.
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Affiliation(s)
- Androula Pavli
- Travel Medicine Office, Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Katerelos
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, Athens, 15123 Greece, Phone: 30-210-5212-175
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20
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van Ravenhorst MB, Bijlsma MW, van Houten MA, Struben VMD, Anderson AS, Eiden J, Hao L, Jansen KU, Jones H, Kitchin N, Pedneault L, Sanders EAM, van der Ende A. Meningococcal carriage in Dutch adolescents and young adults; a cross-sectional and longitudinal cohort study. Clin Microbiol Infect 2017; 23:573.e1-573.e7. [PMID: 28192234 DOI: 10.1016/j.cmi.2017.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Current information on rates and dynamics of meningococcal carriage is essential for public health policy. This study aimed to determine meningococcal carriage prevalence, its risk factors and duration in the Netherlands, where meningococcal C vaccine coverage is >90%. Several methods to identify serogroups of meningococcal carriage isolates among adolescent and young adults were compared. METHODS Oropharyngeal swabs were collected from 1715 participants 13-23 years of age in 2013-2014; 300 were prospectively followed over 8 months. Cultured isolates were characterized by Ouchterlony, real-time (rt-) PCR or whole-genome sequencing (WGS). Direct swabs were assessed by rt-PCR. Questionnaires on environmental factors and behaviour were also obtained. RESULTS A meningococcal isolate was identified in 270/1715 (16%) participants by culture. Of MenB isolates identified by whole genome sequencing, 37/72 (51%) were correctly serogrouped by Ouchterlony, 46/51 (90%) by rt-PCR of cultured isolates, and 39/51 (76%) by rt-PCR directly on swabs. A sharp increase in carriage was observed before the age of 15 years. The age-related association disappeared after correction for smoking, level of education, frequent attendance to crowded social venues, kissing in the previous week and alcohol consumption. Three participants carried the same strain identified at three consecutive visits in an 8-month period. In these isolates, progressively acquired mutations were observed. CONCLUSIONS Whole genome sequencing of culture isolates was the most sensitive method for serogroup identification. Based upon results of this study and risk of meningococcal disease, an adolescent meningococcal vaccination might include children before the age of 15 years to confer individual protection and potentially to establish herd protection.
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Affiliation(s)
- M B van Ravenhorst
- Department of Immunology and Infectious diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - M W Bijlsma
- Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, Amsterdam, The Netherlands
| | - M A van Houten
- Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - V M D Struben
- Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - A S Anderson
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - J Eiden
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - L Hao
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - K U Jansen
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - H Jones
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - N Kitchin
- Pfizer Vaccine Research & Development, Maidenhead, UK
| | - L Pedneault
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - E A M Sanders
- Department of Immunology and Infectious diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A van der Ende
- Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), Department of Medical Microbiology and the Netherlands Reference Laboratory for Bacterial Meningitis, University of Amsterdam, Amsterdam, The Netherlands.
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Meningococcal Carriage in Military Recruits and University Students during the Pre MenB Vaccination Era in Greece (2014-2015). PLoS One 2016; 11:e0167404. [PMID: 27907129 PMCID: PMC5131982 DOI: 10.1371/journal.pone.0167404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/14/2016] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to estimate the meningococcal carriage rate and to identify the genotypic characteristics of the strains isolated from healthy military recruits and university students in order to provide data that might increase our understanding on the epidemiology of meningococcus and obtain information which helps to evaluate the potential effects on control programs such as vaccination., Methods A total of 1420 oropharyngeal single swab samples were collected from military recruits and university students on voluntary basis, aged 18–26 years. New York City Medium was used for culture and the suspected N. meningitidis colonies were identified by Gram stain, oxidase and rapid carbohydrate utilization tests. Further characterisation was carried out by molecular methods (multiplex PCR, MLST, WGS). Results The overall carriage rate was of 12.7%; 15% and 10.4% for recruits and university students respectively. MenB (39.4%) was the most prevalent followed by MenY (12.8%) and MenW (4.4%). Among the initial 76 Non Groupable (NG) isolates, Whole Genome Sequence Analysis (WGS) revealed that 8.3% belonged to MenE, 3.3% to MenX and 1.1% to MenZ, while, 53 strains (29.4%) were finally identified as capsule null. Genetic diversity was found among the MenB isolates, with 41/44 cc and 35 cc predominating. Conclusion Meningococcal carriage rate in both groups was lower compared to our previous studies (25% and 18% respectively) with predominance of MenB isolates. These findings, help to further our understanding on the epidemiology of meningococcal disease in Greece. Although the prevalence of carriage seems to have declined compared to our earlier studies, the predominant MenB clonal complexes (including 41/44cc and 35cc) are associated with invasive meningococcal disease.
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Pelton SI. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines. J Adolesc Health 2016; 59:S3-S11. [PMID: 27449148 DOI: 10.1016/j.jadohealth.2016.04.012] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/11/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is associated with high morbidity and mortality. Although IMD incidence is highest in infants, a second peak occurs in adolescents/young adults. The incidence of IMD and the predominant disease-causing meningococcal serogroups vary worldwide. Epidemiologic data have guided the development of meningococcal vaccines to reduce the IMD burden. In Europe, serogroup C IMD has been substantially reduced since the introduction of a serogroup C conjugate vaccine. Serogroup B predominates in Europe, although cases of serogroup Y IMD have been increasing in recent years. In the United States, declines in serogroup C and Y disease have been observed in association with the introduction of quadrivalent (serogroups ACWY) meningococcal conjugate vaccines; serogroup B persists and is now the most common cause of outbreak associated disease. In the African meningitis belt, a conjugate vaccine for serogroup A has been effective in decreasing meningitis associated with that serogroup. Outbreaks of the previously rare serogroup X disease have been reported in this region since 2006. In recent years, outbreaks of serogroup B IMD, for which vaccines have only recently been approved by the U.S. Food and Drug Administration and the European Medicines Agency, have occurred in Europe and the United States. Targeting meningococcal vaccination to adolescents/young adults may reduce the morbidity and mortality associated with IMD and has the potential to impact the larger community through herd benefits.
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Affiliation(s)
- Stephen I Pelton
- Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts.
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Vossen M, Mitteregger D, Steininger C. Meningococcal pneumonia. Vaccine 2016; 34:4364-70. [PMID: 27443594 DOI: 10.1016/j.vaccine.2016.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Neisseria meningitidis remains the most important cause of bacterial meningitis worldwide, particularly in children and young adults. The second most common and a potentially severe end-organ manifestation of invasive meningococcal disease (excluding systemic sepsis) is meningococcal pneumonia. It occurs in between 5% and 15% of all patients with invasive meningococcal disease and is thus the second most common non-systemic end-organ manifestation. To establish the diagnosis requires a high level of clinical awareness - the incidence is therefore very likely underreported and underestimated. This review of 344 meningococcal pneumonia cases reported in the Americas, Europe, Australia, and Asia between 1906 and 2015 presents risk factors, pathogenesis, clinical manifestations, diagnostic approaches, treatment, and prognosis of meningococcal pneumonia.
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Affiliation(s)
- Matthias Vossen
- Department of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Dieter Mitteregger
- Department of Laboratory Medicine, Div. of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Steininger
- Department of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
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What Would be the Best Schedule for Prevention of Meningococcal Disease in All Ages? The UK Experience. Paediatr Drugs 2016; 18:83-7. [PMID: 26913860 DOI: 10.1007/s40272-016-0169-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meningococcal disease is a major global public health problem, and vaccination is the optimal means of prevention. Meningococcal vaccination programmes have significantly evolved, for example, in the UK, since their introduction in 1999. The UK, the first country to introduce meningococcal serogroup C conjugate (MCC) vaccination, commenced this in 1999 with a primary infant series at 2, 3 and 4 months of age, together with a catch-up campaign of a single dose for children aged 1-18 years. Subsequent changes to the schedule have occurred in response to increasing knowledge about how MCC vaccines work, together with improved knowledge of meningococcal transmission. Firstly, in 2006, the schedule was refined from a three-dose to a two-dose priming schedule with the addition of a booster in the second year of life. This was followed by a further change in 2013, when the number of priming doses was further reduced to a single priming dose along with a booster maintained at 12 months of age and the introduction of an adolescent MCC booster dose. This in 2015 was changed from monovalent serogroup C to quadrivalent A, C, W and Y in response to an outbreak of serogroup W.
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Koch J, Hellenbrand W, Schink S, Wichmann O, Carganico A, Drewes J, Kruspe M, Suckau M, Claus H, Marcus U. Evaluation of a temporary vaccination recommendation in response to an outbreak of invasive meningococcal serogroup C disease in men who have sex with men in Berlin, 2013–2014. Euro Surveill 2016; 21:12-22. [DOI: 10.2807/1560-7917.es.2016.21.5.30122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/11/2015] [Indexed: 11/20/2022] Open
Abstract
Meningococcal serogroup C (MenC) vaccination of men who have sex with men (MSM) was temporarily recommended to control an outbreak of invasive MenC disease among MSM in Berlin in 2012–2013. Vaccination was offered to HIV-infected MSM free of charge; others had to request reimbursement or pay out of pocket. We aimed to assess (i) awareness and acceptance of this recommendation through an online survey of MSM, (ii) implementation through a survey of primary care physicians and analysis of vaccine prescriptions, and (iii) impact through analysis of notified cases. Among online survey respondents, 60% were aware of the recommendation. Of these, 39% had obtained vaccination (70% of HIV-infected, 13% of HIV-negative/non-tested MSM). Awareness of recommendation and vaccination were positively associated with HIV infection, primary care physicians’ awareness of respondents’ sexual orientation, and exposure to multiple information sources. Most (26/30) physicians informed clients about the recommendation. Physicians considered concerns regarding reimbursement, vaccine safety and lack of perceived disease risk as primary barriers. After the recommendation, no further outbreak-related cases occurred. To reach and motivate target groups, communication of a new outbreak-related vaccination recommendation should address potential concerns through as many information channels as possible and direct reimbursement of costs should be enabled.
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Affiliation(s)
- Judith Koch
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Wiebke Hellenbrand
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Susanne Schink
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andreas Carganico
- AIDS working group of practicing physicians Berlin e.V., Berlin, Germany
| | - Jochen Drewes
- Free University Berlin, Public Health, Berlin, Germany
| | - Martin Kruspe
- Free University Berlin, Public Health, Berlin, Germany
| | - Marlen Suckau
- Infectious Disease Protection Unit, Senate Department for Health and Social Affairs, Berlin, Germany
| | - Heike Claus
- University of Würzburg, Institute for Hygiene and Microbiology and National Reference Laboratory for Meningococci, Würzburg, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Oldfield NJ, Harrison OB, Bayliss CD, Maiden MCJ, Ala'Aldeen DAA, Turner DPJ. Genomic Analysis of Serogroup Y Neisseria meningitidis Isolates Reveals Extensive Similarities Between Carriage-Associated and Disease-Associated Organisms. J Infect Dis 2016; 213:1777-85. [PMID: 26747709 DOI: 10.1093/infdis/jiw008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is a frequent colonizer of the human nasopharynx, with asymptomatic carriage providing the reservoir for invasive, disease-causing strains. Serogroup Y (MenY) strains are a major cause of meningococcal disease. High-resolution genetic analyses of carriage and disease isolates can establish epidemiological relationships and identify potential virulence factors. METHODS Whole-genome sequence data were obtained for 99 MenY carriage isolates recovered in the United Kingdom during 1997-2010. Sequences were compared to those of 73 MenY invasive isolates recovered during 2010-2011, using a gene-by-gene approach. RESULTS Comparisons across 1605 core genes resolved 91% of isolates into one of 8 clusters containing closely related disease and carriage isolates. Six clusters contained carried meningococci isolated during 1997-2001, suggesting temporal stability. One cluster of isolates, predominately sharing the designation Y: P1.5-1,10-1: F4-1: ST-1655 (cc23), was resolved into one subcluster with 86% carriage isolates and a second with 90% invasive isolates. These subclusters were defined by specific allelic differences in 5 core genes encoding glycerate kinase (glxK), valine-pyruvate transaminase (avtA), superoxide dismutase (sodB), and 2 hypothetical proteins. CONCLUSIONS High-resolution genetic analyses detected long-term temporal stability and temporally overlapping carriage and disease populations for MenY clones but also evidence of a disease-associated clone.
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Mahida N, Anthony L, Martin N, Gupta A, Andrewartha F. Human bite leading to fatal Neisseria meningitidis septicaemia and pericarditis. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nikunj Mahida
- Department of Clinical Microbiology, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Laura Anthony
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Nicola Martin
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Anindya Gupta
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Fiona Andrewartha
- Department of Clinical Microbiology, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
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Abstract
Neisseria meningitidis is a gram-negative diplococcus, for which humans are the only reservoir. While colonization is common, invasive meningococcal disease in the form of meningitis or bacteremia can be devastating and potentially fatal. Certain populations are at higher risk for disease including infants, adolescents, those with asplenia or complement deficiencies, and potentially those with human immunodeficiency virus (HIV) infection. Use of conjugate meningococcal vaccines has impacted disease epidemiology in both high- and low-income countries. Outbreaks of serogroup B disease at university campuses have drawn further attention to the recent development of a novel serogroup B vaccine now approved in many countries. This review covers key aspects of the pathogenesis and management of meningococcal disease, as well as the very recent developments in disease epidemiology, outbreaks, and the evolution of meningococcal immunizations.
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Moreno J, Hidalgo M, Duarte C, Sanabria O, Gabastou JM, Ibarz-Pavon AB. Characterization of Carriage Isolates of Neisseria meningitides in the Adolescents and Young Adults Population of Bogota (Colombia). PLoS One 2015; 10:e0135497. [PMID: 26322796 PMCID: PMC4556189 DOI: 10.1371/journal.pone.0135497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 07/22/2015] [Indexed: 12/25/2022] Open
Abstract
Background Meningococcal carriage studies are important to improve our understanding of the epidemiology of meningococcal disease. The aim of this study was to determine the prevalence of meningococcal carriage and the phenotypic and genotypic characteristics of isolates collected from a sample of students in the city of Bogotá, Colombia. Materials and Methods A total of 1459 oropharyngeal samples were collected from students aged 15–21 years attending secondary schools and universities. Swabs were plated on a Thayer Martin agar and N. meningitidis was identified by standard microbiology methods and PCR. Results The overall carriage prevalence was 6.85%. Carriage was associated with cohabitation with smokers, and oral sex practices. Non-groupable and serogroup Y isolates were the most common capsule types found. Isolates presented a high genetic diversity, and circulation of the hypervirulent clonal complexes ST-23, ST-32 and ST-41/44 were detected. Conclusion The meningococcal carriage rate was lower than those reported in Europe and Africa, but higher than in other Latin American countries. Our data also revealed antigenic and genetic diversity of the isolates and the circulation of strains belonging to clonal complexes commonly associated with meningococcal disease.
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Affiliation(s)
- Jaime Moreno
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
- * E-mail:
| | - Melissa Hidalgo
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Olga Sanabria
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jean Marc Gabastou
- Pan-American Health Organization, Washington DC, United States of America
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Deasy AM, Guccione E, Dale AP, Andrews N, Evans CM, Bennett JS, Bratcher HB, Maiden MCJ, Gorringe AR, Read RC. Nasal Inoculation of the Commensal Neisseria lactamica Inhibits Carriage of Neisseria meningitidis by Young Adults: A Controlled Human Infection Study. Clin Infect Dis 2015; 60:1512-20. [DOI: 10.1093/cid/civ098] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
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Perrett KP, Richmond PC, Borrow R, Nolan T, McVernon J. Antibody persistence in Australian adolescents following meningococcal C conjugate vaccination. Pediatr Infect Dis J 2015; 34:279-85. [PMID: 25742078 DOI: 10.1097/inf.0000000000000541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Australia, following the introduction of serogroup C meningococcal (MenC) conjugate vaccine for toddlers and catch-up immunization through adolescence, MenC disease incidence plummeted and remains low. However, individual protection following MenC conjugate vaccination, particularly in young children, may be short-lived. We investigated the persistence of MenC serum bactericidal antibody (SBA) titers in adolescents, more than 7 years after a single "catch-up" dose of MenC conjugate vaccine. We also investigated their exposure and susceptibility to meningococcal serogroups A, W and Y. METHODS MenC SBA titers and Men A, C, W and Y IgG geometric mean concentration were measured in 240 healthy 11- to 16-year-old adolescents. The correlate of protection was an rSBA titer of ≥8. RESULTS An rSBA≥8 was observed in 105 [44% (95% confidence interval {CI}, 37-50%)] of 240 adolescents (mean age, 13.2 years, mean interval since MenC immunization, 8.2 years). The proportion with an rSBA≥8, geometric mean rSBA titer and geometric mean IgG concentration increased with age, from 22% to 75%, 3.7 to 33.4 and 0.13 to 0.52 μg/mL, in participants who received MenC vaccine at mean age 2.8 to 7.5 years, respectively. Natural acquired antibody to Men A, W and Y was low with IgG geometric mean concentrations of 1.26, 0.38 and 0.47 μg/mL, respectively. CONCLUSIONS More than half of Australian adolescents have inadequate serological protection against MenC disease and low natural immunity to MenA, W and Y.
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Affiliation(s)
- Kirsten P Perrett
- From the *Vaccine and Immunisation Research Group (VIRGo), Murdoch Childrens Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia, †School of Paediatrics and Child Health, University of Western Australia, Telethon Institute for Child Health Research, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; and ‡Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, Greater Manchester, United Kingdom
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Meningococcal carriage in adolescents in the United Kingdom to inform timing of an adolescent vaccination strategy. J Infect 2015; 71:43-52. [PMID: 25709085 DOI: 10.1016/j.jinf.2015.02.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Recent development of serogroup B meningococcal (MenB) vaccines highlights the importance of pharyngeal carriage data, particularly in adolescents and young adults, to inform implementation strategies. We describe current UK carriage prevalence in this high risk population and compare methods of carriage detection. METHODS In this multisite study, pharyngeal swabs were collected on 3-4 occasions over 6-12 months, from 1040 school and university students, aged 10-25 years. Meningococcal carriage was detected by standard culture combined with seroagglutination or PCR of cultured isolates, or by direct PCR from swab. The factor H binding protein (fHBP) variants present in meningococcal isolates were determined. RESULTS Meningococcal serogroups B and Y were most common, with carriage up to 6.5% and 5.5% respectively, increasing throughout adolescence. Identification by seroagglutination was often unreliable, and the sensitivity of direct PCR detection was 66% compared to culture combined with PCR. Of MenB isolates, 89.1% had subfamily A variants of fHBP. The acquisition rate of MenB carriage was estimated at 2.8 per 1000 person-months. CONCLUSIONS If vaccination is to precede the adolescent rise in MenB carriage, these data suggest it should take place in early adolescence. Studies assessing vaccine impact should use molecular methods to detect carriage.
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Abstract
Neisseria meningitidis, the cause of meningococcal disease, has been the subject of sophisticated molecular epidemiological investigation as a consequence of the significant public health threat posed by this organism. The use of multilocus sequence typing and whole genome sequencing classifies the organism into clonal complexes. Extensive phenotypic, genotypic and epidemiological information is available on the PubMLST website. The human nasopharynx is the sole ecological niche of this species, and carrier isolates show extensive genetic diversity as compared with hyperinvasive lineages. Horizontal gene exchange and recombinant events within the meningococcal genome during residence in the human nasopharynx result in antigenic diversity even within clonal complexes, so that individual clones may express, for example, more than one capsular polysaccharide (serogroup). Successful clones are capable of wide global dissemination, and may be associated with explosive epidemics of invasive disease.
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Affiliation(s)
- R C Read
- Clinical and Experimental Sciences and NIHR Respiratory Biomedical Research Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
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Abstract
The exclusive reservoir of the genus Neisseria is the human. Of the broad range of species that comprise the Neisseria, only two are frequently pathogenic, and only one of those is a resident of the nasopharynx. Although Neisseria meningitidis can cause severe disease if it invades the bloodstream, the vast majority of interactions between humans and Neisseria are benign, with the bacteria inhabiting its mucosal niche as a non-invasive commensal. Understandably, with the exception of Neisseria gonorrhoeae, which preferentially colonises the urogenital tract, the neisseriae are extremely well adapted to survival in the human nasopharynx, their sole biological niche. The purpose of this review is to provide an overview of the molecular mechanisms evolved by Neisseria to facilitate colonisation and survival within the nasopharynx, focussing on N. meningitidis. The organism has adapted to survive in aerosolised transmission and to attach to mucosal surfaces. It then has to replicate in a nutrition-poor environment and resist immune and competitive pressure within a polymicrobial complex. Temperature and relative gas concentrations (nitric oxide and oxygen) are likely to be potent initial signals of arrival within the nasopharyngeal environment, and this review will focus on how N. meningitidis responds to these to increase the likelihood of its survival.
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Harrison LH, Shutt KA, Arnold KE, Stern EJ, Pondo T, Kiehlbauch JA, Myers RA, Hollick RA, Schmink S, Vello M, Stephens DS, Messonnier NE, Mayer LW, Clark TA. Meningococcal carriage among Georgia and Maryland high school students. J Infect Dis 2014; 211:1761-8. [PMID: 25505298 DOI: 10.1093/infdis/jiu679] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meningococcal disease incidence in the United States is at an all-time low. In a previous study of Georgia high school students, meningococcal carriage prevalence was 7%. The purpose of this study was to measure the impact of a meningococcal conjugate vaccine on serogroup Y meningococcal carriage and to define the dynamics of carriage in high school students. METHODS This was a prospective cohort study at 8 high schools, 4 each in Maryland and Georgia, during a school year. Students at participating schools received quadrivalent meningococcal conjugate vaccine that uses diphtheria toxoid as the protein carrier (MCV4-DT). In each state, 2 high schools were randomly assigned for MCV4-DT receipt by students at the beginning of the study, and 2 were randomly assigned for MCV4-DT receipt at the end. Oropharyngeal swab cultures for meningococcal carriage were performed 3 times during the school year. RESULTS Among 3311 students, the prevalence of meningococcal carriage was 3.21%-4.01%. Phenotypically nongroupable strains accounted for 88% of carriage isolates. There were only 5 observed acquisitions of serogroup Y strains during the study; therefore, the impact of MCV4-DT on meningococcal carriage could not be determined. CONCLUSIONS Meningococcal carriage rates in US high school students were lower than expected, and the vast majority of strains did not express capsule. These findings may help explain the historically low incidence of meningococcal disease in the United States.
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Affiliation(s)
- Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pennsylvania
| | - Kathleen A Shutt
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pennsylvania
| | - Kathryn E Arnold
- Georgia Emerging Infections Program Division of Public Health, Georgia Department Human of Resources
| | - Eric J Stern
- National Center for Immunization and Respiratory Diseases Epidemic Intelligence Service Program, Centers for Disease Control and Prevention
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases
| | | | - Robert A Myers
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Rosemary A Hollick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Marianne Vello
- Georgia Emerging Infections Program Division of Public Health, Georgia Department Human of Resources
| | - David S Stephens
- Georgia Emerging Infections Program Emory University School of Medicine VA Medical Center, Atlanta, Georgia
| | | | | | - Thomas A Clark
- National Center for Immunization and Respiratory Diseases
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Abad R, Vázquez J. Vacunas multivalentes frente a enfermedad meningocócica: ¿dentro o fuera de nuestras agendas? An Pediatr (Barc) 2014; 81:329.e1-7. [DOI: 10.1016/j.anpedi.2014.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/26/2022] Open
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Implications of differential age distribution of disease-associated meningococcal lineages for vaccine development. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:847-53. [PMID: 24695776 PMCID: PMC4054250 DOI: 10.1128/cvi.00133-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
New vaccines targeting meningococci expressing serogroup B polysaccharide have been developed, with some being licensed in Europe. Coverage depends on the distribution of disease-associated genotypes, which may vary by age. It is well established that a small number of hyperinvasive lineages account for most disease, and these lineages are associated with particular antigens, including vaccine candidates. A collection of 4,048 representative meningococcal disease isolates from 18 European countries, collected over a 3-year period, were characterized by multilocus sequence typing (MLST). Age data were available for 3,147 isolates. The proportions of hyperinvasive lineages, identified as particular clonal complexes (ccs) by MLST, differed among age groups. Subjects <1 year of age experienced lower risk of sequence type 11 (ST-11) cc, ST-32 cc, and ST-269 cc disease and higher risk of disease due to unassigned STs, 1- to 4-year-olds experienced lower risk of ST-11 cc and ST-32 cc disease, 5- to 14-year-olds were less likely to experience ST-11 cc and ST-269 cc disease, and ≥25-year-olds were more likely to experience disease due to less common ccs and unassigned STs. Younger and older subjects were vulnerable to a more diverse set of genotypes, indicating the more clonal nature of genotypes affecting adolescents and young adults. Knowledge of temporal and spatial diversity and the dynamics of meningococcal populations is essential for disease control by vaccines, as coverage is lineage specific. The nonrandom age distribution of hyperinvasive lineages has consequences for the design and implementation of vaccines, as different variants, or perhaps targets, may be required for different age groups.
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Effectiveness of Immunoprophylaxis in Suppressing Carriage of Neisseria Meningitidis in the Military Environment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 836:19-28. [DOI: 10.1007/5584_2014_22] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Esposito S, Zampiero A, Terranova L, Montinaro V, Scala A, Ansuini V, Principi N. Genetic characteristics of Neisseria meningitidis serogroup B strains carried by adolescents living in Milan, Italy: implications for vaccine efficacy. Hum Vaccin Immunother 2013; 9:2296-303. [PMID: 23880917 DOI: 10.4161/hv.25800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Before a protein vaccine is introduced into a country, it is essential to evaluate its potential impact and estimate its benefits and costs. The aim of this study was to determine the genetic characteristics of Neisseria meningitidis B (NmB) in the pharyngeal secretions of 1375 healthy adolescents aged 13-19 y living in Milan, Italy, in September 2012, and the possible protection offered by the two currently available NmB protein vaccines. Ninety-one subjects were Nm carriers (6.6%), 29 (31.9%) of whom carried the NmB capsular gene. The 29 identified strains belonged to eight clonal complexes (CCs), the majority of which were in the ST-41/44/Lin.3 CC (n = 11; 37.9%). All of the identified strains harboured ƒHbp alleles representing a total of 15 sub-variants: the gene for NHBA protein was found in all but three of the studied strains (10.3%) with 13 identified sub-variants. There were 15 porA sub-types, seven of which were identified in just one CC. The findings of this study seem to suggest that both of the protein vaccines proposed for the prevention of invasive disease due to NmB (the 4-protein and the 2-protein products) have a composition that can evoke a theoretically effective antibody response against the meningococcal strains currently carried by adolescents living in Northern Italy. The genetic characteristics of NmB strains can be easily evaluated by means of molecular methods, the results of which can provide an albeit approximate estimate of the degree of protection theoretically provided by the available vaccines, and the possible future need to change their composition.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic 1; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan, Italy
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Protecting university students in the UK against meningococcal disease: vaccination is the way forward. Perspect Public Health 2013; 133:90-1. [DOI: 10.1177/1757913913475758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Papaevangelou V, Spyridis N. MenACWY-TT vaccine for active immunization against invasive meningococcal disease. Expert Rev Vaccines 2012; 11:523-37. [PMID: 22827239 DOI: 10.1586/erv.12.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Meningococcal disease remains a significant global cause of morbidity and mortality despite the availability of polysaccharide and conjugate vaccines. The implementation of monovalent meningococcal serogroup C vaccine in developed countries has significantly decreased the incidence of meningococcal disease, while the recent introduction of monovalent serogroup A conjugate vaccine in the African meningitis belt aims to reduce the incidence of high endemic disease in this area. Three quadrivalent meningococcal vaccines have already been licensed; a polysaccharide (MenACWY-PS) and two conjugated (MenACWY-DT and MenACWY-CRM) vaccines. An investigational MenACWY-TT vaccine is described in this article. Clinical trials in infants older than 9 months of age, toddlers, children, adolescents and adults have indicated that this vaccine is well tolerated and immunogenic. The inclusion of a spacer molecule coupled with the polysaccharide (for serogroups A and C) and tetanus toxoid as the carrier protein aims to elicit robust immune responses. The tolerability of this vaccine is comparable to that of polysaccharide quadrivalent vaccines and monovalent meningococcal serogroup C vaccines. More importantly, the immunogenicity, antibody persistence and induction of immune memory aim to provide protection to a wide range of susceptible subjects.
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Affiliation(s)
- Vassiliki Papaevangelou
- National and Kapodistrian University of Athens Medical School, Athens University, Goudi 11527, Athens, Greece.
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Seroprevalence of serum bactericidal antibodies against group W135 and Y meningococci in England in 2009. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 19:219-22. [PMID: 22190393 DOI: 10.1128/cvi.05515-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serological surveillance has been used in the United Kingdom to inform vaccine policy for several infections, including those with group C meningococci. Meningococcal conjugate vaccines, containing capsular groups A, W135, and Y in addition to C, are now available, but their use in the United Kingdom is restricted to at-risk groups and travelers to areas of endemicity. The aim of this study was to establish a baseline for natural immunity for groups W135 and Y. Serum samples collected in 2009 from individuals of all ages were obtained from the Health Protection Agency Seroepidemiology Unit, which collects residual sera from participating laboratories across the country. Serum bactericidal antibody (SBA) activity against two reference strains, representing groups Y (strain M03 241125) and W135 (strain M01 240070), was determined with 1,191 sera using a standardized complement-mediated SBA assay, with complement derived from baby rabbits (rSBA). The age-specific geometric mean titers (GMTs) and percentages of individuals with rSBA titers of ≥ 8 were calculated, together with 95% confidence intervals (CI). Overall, 18.4% and 19.6% had rSBA titers of ≥ 8 for groups W135 and Y, respectively. Antibody prevalence varied by age. In general, rSBA titers were low for younger children, with serum samples from 7% and 13% of children under 5 years achieving titers of ≥ 8 against groups W135 and Y, respectively. GMTs peaked for 20- to 24-year-olds for group W135 (GMT, 7.1; 95% CI, 4.7, 10.9) and for 30- to 44-year-olds for group Y (GMT, 8.6; 95% CI, 5.9, 12.7). Unlike seroprevalence against group B meningococci, there was not an obvious peak in SBA titers in samples from teenagers. Natural immunity against group W135 and Y meningococci in England appears to be low.
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Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, McIntyre P, Ramsay ME, Sáfadi MAP. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2011; 30 Suppl 2:B26-36. [PMID: 22178525 DOI: 10.1016/j.vaccine.2011.12.032] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/04/2011] [Accepted: 12/05/2011] [Indexed: 01/05/2023]
Abstract
The epidemiology of invasive meningococcal disease continues to change rapidly, even in the three years since the first Meningococcal Exchange Meeting in 2008. Control of disease caused by serogroup C has been achieved in countries that have implemented meningococcal C or quadrivalent meningococcal ACWY conjugate vaccines. Initiation of mass immunization programs with meningococcal A conjugate vaccines across the meningitis belt of Africa may lead to the interruption of cyclical meningococcal epidemics. A meningococcal B vaccination program in New Zealand has led to a decreased incidence of high rates of endemic serogroup B disease. Increases in serogroup Y disease have been observed in certain Nordic countries which, if they persist, may require consideration of use of a multiple serogroup vaccine. The imminent availability of recombinant broadly protective serogroup B vaccines may provide the tools for further control of invasive meningococcal disease in areas where serogroup B disease predominates. Continued surveillance of meningococcal disease is essential; ongoing global efforts to improve the completeness of reporting are required.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, the IWK Health Centre, and Capital Health, Halifax, Canada.
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