Research LettersSerogroup W135 meningococcal disease in Hajj pilgrims
Summary
An outbreak of W135 meningococcal disease occurred in the spring of 2000 among pilgrims retuming from Saudi Arabia and their contacts. Clinical isolates from England and France were examined and compared with reference strains from other countries. Characterisation of isolates by a range of typing methods showed them to be of clonal origin (ET-37) and closely related to other meningococcl with an established propensity to cause disease clusters. A reappraisal of vaccination strategies for travellers is required.
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Cited by (244)
Bacterial Meningitis
2023, Manson's Tropical Diseases, Fourth EditionBacterial meningitis is a medical emergency that is common in many areas of the tropics. The epidemiology varies with geographical and climatic conditions, with age, with rate of HIV infection and other causes of immunosuppression, and with the availability of vaccines. The epidemiology has substantially changed in the past 25 years after the introduction of vaccines against Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis, although only recently these vaccinations have reached populations in research poor settings, where the incidence is highest. Currently, two pathogens cause most cases outside the neonatal period: Streptococcus pneumoniae and Neisseria meningitidis. Neonatal meningitis may also be caused by these organisms but other bacteria such as Escherichia coli, Streptococcus agalactiae (Group B streptococcus), and Klebsiella pneumoniae tend to predominate. The relative importance of H. influenzae, pneumococci, and meningococci outside the neonatal period varies according to country; for example, in humid low-lying regions S. pneumoniae and H. influenzae predominate, whereas in dryer regions, for example the meningitis belt of sub-Saharan Africa, the meningococcus causes vast spreading epidemics. Bacterial meningitis has a high mortality and carries a high risk of neurological sequelae.
Historical review of vaccination against meningococcus in Spain (1996-2021). Learned lessons
2023, VacunasLa enfermedad meningocócica invasiva (EMI) es una causa de morbimortalidad importante que afecta principalmente a los lactantes y a los adolescentes. El progresivo desarrollo de las vacunas en los últimos 25 años ha permitido el abordaje preventivo de la enfermedad a través de diferentes estrategias en función de los cambios epidemiológicos y de la disponibilidad de preparados vacunales. El presente trabajo es una revisión histórica sobre las diferentes estrategias de inmunoprevención y su impacto frente a la EMI, establecidas entre los años 1996 y 2021 en España. En la actualidad, solo las vacunas han demostrado capacidad de prevención de esta enfermedad. En línea a los objetivos establecidos por la Organización Mundial de la Salud (OMS) en la iniciativa de «Derrotar a la meningitis en el año 2030» y con base en la evidencia del impacto y efectividad de las vacunas actuales, se hace necesario incorporar nuevas medidas preventivas frente a la enfermedad meningocócica invasiva, sobre todo en las cohortes de edad que sufren mayor incidencia como son los lactantes y los adolescentes.
Invasive meningococcal disease is a major cause of morbidity and mortality, primarily affecting infants and adolescents. The progressive development of vaccines in the last 25 years has allowed a preventive approach to the disease through different strategies based on epidemiological changes and the availability of vaccine preparations. This paper is a historical review of the different immunoprevention strategies and their impact against EMI established between 1996 and 2021 in Spain. Currently, only vaccines have demonstrated the ability to prevent this disease. In line with the objectives established by the World Health Organization in the initiative «Defeat meningitis in the year 2030» and based on the evidence of the impact and effectiveness of current vaccines, it is necessary to incorporate new preventive measures against invasive meningococcal disease, especially in the age cohorts with the highest incidence, such as infants and adolescents.
Impact of an adolescent meningococcal ACWY immunisation programme to control a national outbreak of group W meningococcal disease in England: a national surveillance and modelling study
2022, The Lancet Child and Adolescent HealthIn August, 2015, the UK implemented an emergency adolescent immunisation programme with the meningococcal ACWY conjugate vaccine to combat a national outbreak of meningococcal group W (MenW) disease due to a hypervirulent ST-11 complex strain, which is currently causing regional and national outbreaks worldwide. This immunisation programme specifically targeted adolescents aged 13–18 years, an age group with low disease incidence but high nasopharyngeal carriage, with the aim of interrupting transmission and providing indirect (herd) protection across the population. Here, we report the impact of the first 4 years of the programme in England.
Public Health England conducts meningococcal disease surveillance in England. Laboratory-confirmed cases of invasive meningococcal disease during the academic years 2010–11 to 2014–15 (Sept 1 to Aug 31) were used to predict post-vaccination trends, based on the assumption that cases would plateau 1 year after vaccine implementation (conservative scenario) or that cases would continue to rise for 4 years after vaccine implementation (extreme scenario). Vaccine uptake evaluated in August, 2019, was 37–41% in adolescents aged 18 years immunised in primary care and 71–86% in younger teenagers routinely vaccinated in school. Vaccine effectiveness was estimated with the indirect screening method.
MenW and MenY cases plateaued within 12 months and then declined, while MenC cases remained low throughout. Significant reductions were observed among adolescents aged 14–18 years for MenW (incidence rate ratio [IRR] 0·35 [95% CI 0·17–0·76]) and MenY (0·21 [0·07–0·59]) cases, with a non-significant reduction in MenC cases (0·11 [0·01–1·01]). Based on conservative and extreme scenarios, 205–1193 MenW cases were prevented through the indirect effects of the programme and 25 through direct protection. For MenY, an estimated 60–106 cases were prevented through the indirect effects of the programme and 19 through direct protection. Ignoring any residual effect from an earlier MenC-containing vaccine, the overall vaccine effectiveness against MenCWY disease combined was 94% (95% CI 80–99).
A meningococcal immunisation programme specifically targeting adolescent carriers succeeded in rapidly controlling a national MenW outbreak, even with moderate initial vaccine uptake.
Public Health England.
Comparative genomic analyses of Chinese serogroup W ST-11 complex Neisseria meningitidis isolates
2020, Journal of InfectionAlthough serogroup W ST-11 complex (cc11) (W:cc11) Neisseria meningitidis has been widespread in China over the past ten years, its origin and genetic relatedness has not yet been described. In this study, we described the genetic relatedness and discuss the possible origin of Chinese W:cc11 isolates by comparing their genome sequences with those of other cc11 strains globally.
Comparative genomic analysis with geo-temporally diverse cc11 isolates showed that the Chinese W:cc11 isolates exclusively formed two closely related subclusters within a distinct sublineage (proposed as the Chinese-strain sublineage) of lineage 11.1 close to the interface between the Hajj-strain sublineage and the South American-strain sublineage. Several isolates from Africa and Europe were closely related to the Chinese subclusters which were largely segregated from one another among distinct provinces of China. No alleles were identified that were unique to the Chinese isolates as a whole, though each subcluster possessed unique alleles differentiating itself from the other subcluster as well as closely related isolates within the extended sublineage. Three genes differentiated the two subclusters with allele combinations that were each present among the non-Chinese isolates within the wider sublineage. These results indicate that the Chinese W:cc11 isolates formed part of a previously undescribed W:cc11 sublineage that is closely related to, but distinct from, the Hajj-strain sublineage and South American-strain sublineage. The geographical source of the Chinese subclusters was indeterminate based on available data.
Population structure of invasive Neisseria meningitidis in the United States, 2011–15
2018, Journal of InfectionMeningococcal conjugate vaccines (MenACWY) were licensed in the United States in 2005. We assessed the population structure of invasive Neisseria meningitidis (Nm) ten years after recommended use of MenACWY among adolescents.
Meningococcal isolates obtained through Active Bacterial Core surveillance (ABCs) from 2000–05, 2006–10, and 2011–15 underwent whole genome or Sanger sequencing. Genome phylogenies were completed using maximum likelihood methods; and distribution of multilocus sequence typing (MLST) sequence type (ST) and clonal complex (CC), and PorA and FetA types were assessed.
Prevalent serogroups (B, C, Y and W), CCs, and PorA and FetA types were detected in all three time periods, but dynamic changes were observed. The proportion of serogroup W CC11 isolates increased in 2011–15 and were most related to South American strains. Changes in CC distribution were also observed in serogroup C and serogroup Y. Phylogenetic analysis showed that U.S. serogroup W CC11s are closely related to a subset of U.S. serogroup C isolates; combined global analysis demonstrated that some CCs, including CC11, exhibit regional clustering.
Overall, the Nm population structure has remained stable after MenACWY introduction. Dynamic changes in genotypes, unlikely related to vaccination, also occurred, highlighting the need for continued whole genome-based surveillance.
MenB-FHbp (Trumenba®; bivalent rLP2086) is a meningococcal serogroup B vaccine containing 2 variants of the recombinant lipidated factor H binding protein (FHbp) antigen. The expression of FHbp, an outer membrane protein, is not restricted to serogroup B strains of Neisseria meningitidis (MenB). This study investigated whether antibodies elicited by MenB-FHbp vaccination also protect against non-MenB strains. Immunological responses were assessed in serum bactericidal assays using human complement (hSBAs) with non-MenB disease-causing test strains from Europe, Africa, and the United States. Importantly, FHbp variant distribution varies among meningococcal serogroups; therefore, strains that code for serogroup-specific prevalent variants (ie, representative of the 2 antigenically distinct FHbp subfamilies, designated subfamily A and subfamily B) and with moderate levels of FHbp surface expression were selected for testing by hSBA. After 2 or 3 doses of MenB-FHbp, 53% to 100% of individuals had bactericidal responses (hSBA titers ≥ 1:8) against meningococcal serogroup C, W, Y, and X strains, and 20% to 28% had bactericidal responses against serogroup A strains; in fact, these bactericidal responses elicited by MenB-FHbp antibodies against non-MenB strains, including strains associated with emerging disease, were greater than the serological correlate of protection for meningococcal disease (ie, hSBA titers ≥ 1:4). This is in comparison to a quadrivalent polysaccharide conjugate vaccine, MCV4 (Menactra®, targeting meningococcal serogroups A, C, W, and Y), which elicited bactericidal responses of 90% to 97% against the serogroup A, C, W, and Y strains and had no activity against serogroup X. Together, these results provide clinical evidence that MenB-FHbp may protect against meningococcal disease regardless of serogroup.