ABSTRACT
The Northern part of Ghana lies within the African meningitis belt and has historically been experiencing seasonal meningitis outbreaks. Despite the continuous meningitis outbreak in the region, the risk factors contributing to the occurrence of these outbreaks have not been clearly identified. This study, therefore, sought to describe the clinical characteristics and possible risk factors associated with meningitis outbreaks in the Upper West Region (UWR). A 1:2 matched case-control study was conducted in May-December 2021 to retrospectively investigate possible risk factors for meningitis outbreak in the UWR of Ghana between January and December 2020. Cases were persons with laboratory confirmed meningitis, and controls were persons of similar age and sex without meningitis living in the same house or neighborhood with a confirmed case. Both primary and secondary data including clinical, socio-demographic and laboratory information were collected and entered on standard questionnaires. Data was analyzed using descriptive statistics and conditional logistic regression. Meningitis cases were mostly due to Streptococcus pneumoniae (67/98; 68.37%), followed by Neisseria meningitides serogroup X (27/98; 27.55%). Fever occurred in 94.03% (63/67) of Streptococcus pneumoniae cases and 100% in both Neisseria meningitidis serogroup X (27/27) and Neisseria meningitidis serogroup W groups (3/3). CSF white cell count was significantly associated with the causative agents of meningitis. Conditional logistic regression analysis showed that, passive exposure to tobacco [AOR = 3.65, 95%CI = 1.03-12.96], bedrooms with 3 or more people [AOR = 4.70, 95%CI = 1.48-14.89] and persons with sore throat infection [AOR = 8.97, 95%CI = 2.73-29.43] were independent risk factors for meningitis infection. Headache, fever and neck pain continue to be the most common symptoms reported by meningitis patients. Education and other preventive interventions targeting exposure to tobacco smoke and crowded rooms would be helpful in reducing meningitis outbreaks in the Upper West Region of Ghana.
Subject(s)
Disease Outbreaks , Humans , Ghana/epidemiology , Male , Female , Case-Control Studies , Risk Factors , Adult , Adolescent , Child , Middle Aged , Young Adult , Child, Preschool , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/microbiology , Retrospective Studies , Streptococcus pneumoniae/isolation & purification , Streptococcus pneumoniae/pathogenicity , Neisseria meningitidis/isolation & purification , Infant , Meningitis, Pneumococcal/epidemiologyABSTRACT
Since 1941, outbreaks of Neisseria meningitidis have been recorded in Chile which, to date, have varied according to clinical form, incidence, lethality, and the responsible serogroup. OBJECTIVE: To summarize the available evidence on the epidemiological profile of acute bacterial meningitis due to Neisseria meningitidis in Chile, analyzing the incidence between 1990 and 2019. METHOD: A systematized review of primary articles was carried out following the Cochrane Collaboration standards. The information sources were PubMed, Scielo, and LILACS. Publications on acute bacterial meningitis due to Neisseria meningitidis were included, with a descriptive design, and in English and Spanish. Studies on the effectiveness of vaccines and diagnostic techniques were excluded. RESULTS: Between 1990 and 2019, the evidence collected focuses exclusively on the year 2012. Of the 133 cases of invasive meningococcal disease (IMD) reported that year, 42 cases presented with meningitis. Of the IMD cases caused by serogroup W135 strains, 21.7% of the cases presented with meningitis (13 cases), compared with the "Non-W135" strains, in which it was 67.4% (29 cases). Lethality due to IMD was higher in patients affected by serogroup W135 (26.7%), compared with patients affected by serogroup "Non-W135" (13.9%). DISCUSSION: The year 2012 shows a change in the prevalent serogroup from serogroup B to W, with a decrease in cases of meningitis and an increase in cases of meningo- coccemia and the lethality of IMD.
Subject(s)
Meningitis, Meningococcal , Neisseria meningitidis , Chile/epidemiology , Humans , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/diagnosis , Incidence , Neisseria meningitidis/classification , Neisseria meningitidis/isolation & purification , Disease Outbreaks , Serogroup , ChildABSTRACT
Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document.
Subject(s)
Meningitis, Meningococcal , Humans , Spain/epidemiology , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/prevention & control , Incidence , Meningococcal Vaccines , Neisseria meningitidis , Child , Child, Preschool , AdolescentABSTRACT
On 6 March 2023, Neisseria meningitidis serogroup C was isolated from a cerebral spinal fluid sample from Obongi District, Uganda. This sample was one of many from patients who were presenting with fever, convulsions, and altered consciousness. We investigated to determine the scope of the meningitis cluster, identify risk factors of contracting meningitis, and inform control measures. We reviewed medical records, conducted active community case finding, and conducted key informant interviews in the affected communities to identify cases and factors associated with contracting meningitis. We analysed case data by person, place, and time. Between 22 December 2022 and 1 May 2023, 25 cases with 2 deaths of bacterial meningitis occurred in Palorinya Refugee Settlement, Obongi District. Of these, 4 were laboratory-confirmed with Neisseria meningitidis serogroup C, 6 were probable cases, and 15 were suspected cases. Most (76%) of case-patients were <18 years old with a median age of 12 years (range 1-66 years). None of the case-patients was vaccinated against Neisseria meningitidis serogroup C. Each case-patient was from a different household and there was no epidemiological link between any of the cases. This meningococcal meningitis cluster caused by Neisseria meningitidis serogroup C occurred among non-vaccinated persons mostly aged <18 years in Palorinya Refugee Settlement. We recommended vaccination of at-risk persons.
Subject(s)
Meningitis, Meningococcal , Neisseria meningitidis, Serogroup C , Neisseria meningitidis , Refugees , Humans , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Uganda/epidemiology , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/prevention & control , VaccinationABSTRACT
Importance: Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort. Objective: To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden. Design, Setting, and Participants: This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023. Exposure: A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021. Main Outcomes and Measures: Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood. Results: The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32â¯607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median. Conclusions and Relevance: The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.
Subject(s)
Deafness , Hearing Loss , Meningitis, Bacterial , Meningitis, Haemophilus , Meningitis, Meningococcal , Meningitis, Pneumococcal , Child , Humans , Male , Female , Infant , Child, Preschool , Sweden/epidemiology , Cohort Studies , Retrospective Studies , Meningitis, Haemophilus/epidemiology , Meningitis, Meningococcal/epidemiology , Meningitis, Bacterial/complications , Meningitis, Bacterial/epidemiology , Meningitis, Pneumococcal/epidemiology , Hearing Loss/epidemiology , Hearing Loss/etiology , SeizuresABSTRACT
Cerebrospinal meningitis (CSM) is a public health burden in Ghana that causes up to 10% mortality in confirmed cases annually. About 20% of those who survive the infection suffer permanent sequelae. The study sought to understand the predictive signs and symptoms of bacterial meningitis implicated in its outcomes. Retrospective data from the Public Health Division, Ghana Health Service on bacterial meningitis from 2015 to 2019 was used for this study. A pre-tested data extraction form was used to collect patients' information from case-based forms kept at the Disease Control Unit from 2015 to 2019. Data were transcribed from the case-based forms into a pre-designed Microsoft Excel template. The data was cleaned and imported into SPSS version 26 for analysis. Between 2015 and 2019, a total of 2446 suspected bacterial meningitis cases were included in the study. Out of these, 842 (34.4%) were confirmed. Among the confirmed cases, males constituted majority with 55.3% of the cases. Children below 14 years of age were most affected (51.4%). The pathogens commonly responsible for bacterial meningitis were Neisseria meningitidis (43.7%) and Streptococcus pneumoniae (53.0%) with their respective strains Nm W135 (36.7%), Nm X (5.1%), Spn St. 1 (26.2%), and Spn St. 12F/12A/12B/44/4 (5.3%) accounting for more than 70.0% of the confirmed cases. The presence of neck stiffness (AOR = 1.244; C.I 1.026-1.508), convulsion (AOR = 1.338; C.I 1.083-1.652), altered consciousness (AOR = 1.516; C.I 1.225-1.876), and abdominal pains (AOR = 1.404; C.I 1.011-1.949) or any of these signs and symptoms poses a higher risk for testing positive for bacterial meningitis adjusting for age. Patients presenting one and/or more of these signs and symptoms (neck stiffness, convulsion, altered consciousness, and abdominal pain) have a higher risk of testing positive for bacterial meningitis after statistically adjusting for age.
Subject(s)
Meningitis, Bacterial , Meningitis, Meningococcal , Child , Male , Humans , Ghana/epidemiology , Retrospective Studies , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/epidemiology , Meningitis, Meningococcal/diagnosis , Meningitis, Meningococcal/epidemiology , Abdominal Pain , SeizuresABSTRACT
Meningitis, a disease that commonly manifests in African meningitis belt, continues to be a public health problem as it is a fatal disease that leave survivors with long-term effects. Most cases of meningitis are due to bacterial and viral infection, although parasites, fungus, cancer, drugs, and immune disorders can rarely cause meningitis. Stiff neck, high temperature, light sensitivity, disorientation, headaches, and vomiting are the most typical symptoms of meningitis. Niger, being in African meningitis belt, has been affected by many meningitis outbreaks. Since 2015, a total of 20,789 cases and 1369 fatalities (CFR 6.6%) have been documented in Niger. In contrast to earlier seasons, the current outbreak of meningitis in Niger exhibits both an increase in the number of cases and a rise in the growth rate. A total of 559 cases of meningitis, including 18 fatalities (overall CFR 3.2%), were reported in the Zinder Region, southeast of Niger, from 1 November 2022 to 27 January 2023, compared to 231 cases reported from 1 November 2021 to 31 January 2022. In the current outbreak, the Neisseria meningitidis serogroup C (NmC) is responsible for the majority of laboratory confirmed cases (104/111; 93.7%). To organize the response to the outbreak, a global team of WHO and other partners, including MSF and UNICEF, has been sent to Niger. Even though there are many challenges in battle against meningitis in Niger, immunization, antibiotics administration and strong disease surveillance are recommended techniques to cope with the current meningitis outbreak in Niger.
Subject(s)
Meningitis, Meningococcal , Neisseria meningitidis, Serogroup C , Humans , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/microbiology , Meningitis, Meningococcal/prevention & control , Niger/epidemiology , Disease Outbreaks , VaccinationABSTRACT
BACKGROUND: Serogroup A Neisseria meningitidis was the major cause of meningococcal meningitis epidemics in the African meningitis belt before 2010 when the monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Therefore, this study aimed to establish the trends in N. meningitidis serogroups from 2016 to 2020 in Ghana's meningitis belt. METHODS: Polymerase chain reaction (PCR) confirmed laboratory results of suspected cases of cerebrospinal meningitis from January, 2016 to March, 2020 were obtained from the Tamale Public Health Laboratory. The data were subjected to trend analysis using Statistical Package for the Social Sciences version 25. Differences between discrete variables were analyzed using the Cochran-Armitage trend test. RESULTS: Of the 2,426 suspected cases, 395 (16.3%) were confirmed positive for N. meningitidis using PCR. Serogroup X showed a significant upward trend (P < 0.01), and serogroup W showed a downward trend (P < 0.01). However, no significant trend was observed for any other serogroup. CONCLUSION: This study showed the emergence of serogroup X, a non-vaccine type, as the predominant N. meningitidis serogroup in the wake of a declining serogroup W in Ghana's meningitis belt.
Subject(s)
Meningitis, Meningococcal , Meningococcal Vaccines , Neisseria meningitidis , Humans , Serogroup , Retrospective Studies , Ghana/epidemiology , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/prevention & controlABSTRACT
INTRODUCTION: Representative information on disease course and outcome of invasive meningococcal disease (IMD) is important because of the shift in meningococcal epidemiology that recently occurred in the Netherlands. With this study, we update earlier research on the burden of IMD in the Netherlands. MATERIAL AND METHODS: We performed a retrospective study using Dutch surveillance data on IMD from July 2011 to May 2020. Clinical information was collected from hospital records. The effect of age, serogroup, and clinical manifestation on disease course and outcome was assessed in multivariable logistic regression analyses. Grouping of infecting isolates was performed by Ouchterlony gel diffusion or by PCR. RESULTS: Clinical information was collected for 278 IMD cases of which the majority had IMD-B (55%), followed by IMD-W (27%), IMD-Y (13%), and IMD-C (5%). Most patients presented with meningitis (32%) or sepsis (30%). Hospitalisation for ≥ 10 days was most frequent among 24-64 year olds (67%). ICU admission was highest among 24-64 year olds (60%), and in case of sepsis (70%), or sepsis plus meningitis (61%). Sequelae at discharge was lower for patients with mild meningococcaemia compared to patients with sepsis plus meningitis (OR: 0.19, 95% CI: 0.07-0.51). The overall case fatality rate was 7%, and was highest for IMD-Y (14%) and IMD-W (13%) patients. CONCLUSIONS: IMD remains a disease with high morbidity and mortality. Sepsis (with or without meningitis) is associated with a more severe disease course and outcome compared to other clinical manifestations. The high disease burden can be partly prevented by meningococcal vaccination.
Subject(s)
Meningitis, Meningococcal , Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Sepsis , Humans , Netherlands/epidemiology , Retrospective Studies , Incidence , Meningococcal Infections/prevention & control , Sepsis/epidemiology , Serogroup , Meningococcal Vaccines/therapeutic use , Meningitis, Meningococcal/epidemiologyABSTRACT
Objetivo: La Enfermedad Meningocócica Invasiva es una causa frecuente de morbimortalidad mundial. El objetivo de este estudioes describir la epidemiología de la enfermedad meningocócica en República Dominicana desde 2012 a 2022 y proponer las basespara su prevención.Método: En el análisis se calcularon incidencias, tasas de hospitalización por cada 100.000 habitantes, tasas de letalidad y se hizouna comparación entre grupos de edad de los 325 casos de meningococcemia reportados en el Sistema Nacional de VigilanciaEpidemiológica Dominicano durante estos 10 años.Resultados principales: El 33% de los casos (103) tenía menos de 5 años. Este grupo de edad fue el que tuvo la tasa de hospitalizaciónmás alta, la mayor tasa de mortalidad en edad pediátrica la mayor letalidad.Conclusiones: Si la República Dominicana vacunara a su población, debería comenzar con los menores de 5 años, y así se reduciríanlas hospitalizaciones, muertes, complicaciones y secuelas producidas por el meningococo. (AU)
Objective: Invasive meningococcal disease is a frequent cause of morbidity and mortality worldwide. The aim of this study is todescribe the epidemiology of meningococcal disease in the Dominican Republic from 2012 to 2022 and to propose the basis for itsprevention.Methods: Incidences, hospitalization rates per 100,000 population, case fatality rates and a comparison between age groups ofthe 325 cases of meningococcemia reported in the Dominican National Epidemiological Surveillance System during these 10 yearswere calculated in the analysis.Main results: 33% of the cases (103) were less than 5 years old. This age group had the highest hospitalization rate, the highestmortality rate in pediatric age and the highest case fatality rate.Conclusions: If the Dominican Republic were to vaccinate its population, it should start with those under 5 years of age, and thiswould reduce hospitalizations, deaths, complications and sequelae caused by meningococcus. (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Meningitis, Meningococcal/diagnosis , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/mortality , Meningitis, Meningococcal/therapy , Meningitis/epidemiology , Meningococcal Infections/mortality , Meningococcal Infections/epidemiology , Immunization Programs , Dominican Republic/epidemiologyABSTRACT
Despite improved surveillance capacities and WHO recommendations for subdistrict analysis, routine epidemic surveillance of acute bacterial meningitis in the African meningitis belt remains largely limited to the district level. We evaluated the appropriateness and performance of analyses at higher spatial resolution. We used suspected meningitis surveillance data at health centre (HC) resolution from Burkina Faso from 14 health districts spanning years 2004-2014 and analysed them using spatio-temporal statistics and generative models. An operational analysis compared epidemic signals at district and HC-level using weekly incidence thresholds. Eighty-four percent (N = 98/116) of epidemic clusters spanned only one HC-week. Spatial propagation of epidemic clusters was mostly limited to 10-30 km. During the 2004-2009 (with serogroup A meningitis) and 2010-2014 (after serogroup A elimination) period, using weekly HC-level incidence thresholds of 100 and 50 per 100,000 respectively, we found a gain in epidemic detection and timeliness in 9 (41% of total) and 10 (67%), respectively, district years with at least one HC signal. Individual meningitis epidemics expanded little in space, suggesting that a health centre level analysis is most appropriate for epidemic surveillance. Epidemic surveillance could gain in precision and timeliness by higher spatial resolution. The optimal threshold should be defined depending on the current background incidence of bacterial meningitis.
Subject(s)
Epidemics , Meningitis, Bacterial , Meningitis, Meningococcal , Humans , Meningitis, Meningococcal/epidemiology , Burkina Faso/epidemiology , Meningitis, Bacterial/epidemiology , Meningitis, Bacterial/complications , IncidenceABSTRACT
This review summarizes the recent Global Meningococcal Initiative (GMI) regional meeting, which explored meningococcal disease in North America. Invasive meningococcal disease (IMD) cases are documented through both passive and active surveillance networks. IMD appears to be decreasing in many areas, such as the Dominican Republic (2016: 18 cases; 2021: 2 cases) and Panama (2008: 1 case/100,000; 2021: <0.1 cases/100,000); however, there is notable regional and temporal variation. Outbreaks persist in at-risk subpopulations, such as people experiencing homelessness in the US and migrants in Mexico. The recent emergence of ß-lactamase-positive and ciprofloxacin-resistant meningococci in the US is a major concern. While vaccination practices vary across North America, vaccine uptake remains relatively high. Monovalent and multivalent conjugate vaccines (which many countries in North America primarily use) can provide herd protection. However, there is no evidence that group B vaccines reduce meningococcal carriage. The coronavirus pandemic illustrates that following public health crises, enhanced surveillance of disease epidemiology and catch-up vaccine schedules is key. Whole genome sequencing is a key epidemiological tool for identifying IMD strain emergence and the evaluation of vaccine strain coverage. The Global Roadmap on Defeating Meningitis by 2030 remains a focus of the GMI.
Subject(s)
Meningitis, Meningococcal , Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Humans , Incidence , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , Neisseria meningitidis/genetics , Vaccines, Conjugate , Meningitis, Meningococcal/epidemiologyABSTRACT
OBJECTIVES: Providing country-specific estimates of case fatality and sequelae from bacterial meningitis (BM) is important to evaluate and monitor progress toward the World Health Organization's roadmap to "defeating meningitis by 2030". METHODS: From 2016-2020, GERMS-SA conducted enhanced surveillance at 26 hospitals across South Africa. Episodes of laboratory-confirmed BM due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis were included. Risk factors for in-hospital death and sequelae at hospital discharge among survivors were analyzed. RESULTS: Of 12,717 invasive bacterial infections reported nationally, 39% (4980) were from enhanced surveillance sites, including 4159 pneumococcal, 640 H. influenzae, and 181 meningococcal infections. BM accounted for 32% (1319/4159) of pneumococcal, 21% (136/640) of H. influenzae, and 83% (151/181) of meningococcal invasive diseases. Clinical data were available for 91% (1455/1606) of BM: 26% (376/1455) were aged <5 years, 50% (726/1455) were female, and 62% (723/1171) with known HIV results, were HIV-infected. In-hospital case fatality was 37% (534/1455), and 24% (222/921) of survivors had adverse sequelae. Risk factors for death included altered mental status, HIV infection, and comorbidities. Risk factors for adverse sequelae included altered mental status and antimicrobial nonsusceptibility. CONCLUSION: BM in South Africa has a high case fatality, and adverse sequelae frequently occur among survivors. Those with comorbidities (including HIV) are at the highest risk.
Subject(s)
HIV Infections , Meningitis, Bacterial , Meningitis, Meningococcal , Meningitis, Pneumococcal , Neisseria meningitidis , Disease Progression , Female , Haemophilus influenzae , Hospital Mortality , Humans , Infant , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/epidemiology , Meningitis, Bacterial/microbiology , Meningitis, Meningococcal/epidemiology , South Africa/epidemiology , Streptococcus pneumoniaeABSTRACT
OBJECTIVES: To analyze clinical meningococcal strains associated with meningococcal septic arthritis cases in England and Wales, and to identify associations between patient age, the synovial joint affected and strain characteristics. METHODS: IMD cases confirmed by the Meningococcal Reference Unit (UK Health Security Agency) between January 2010 and December 2020 were included in the analysis. Septic arthritis cases were defined as those featuring detection and/or isolation of N. meningitidis from an articular site. Capsular grouping was performed by serology on clinical isolates and/or real-time PCR on clinical samples. RESULTS: We identified 162 cases of meningococcal septic arthritis, representing 2% of all invasive meningococcal disease cases during the study period. The knee and the hip were the most commonly affected joints, with the former significantly more frequent in adults and the latter seen more commonly in children and adolescents. Group B strains were between 2 and 6 times less likely to cause septic arthritis in relation to groups W, C and Y strains. CONCLUSIONS: Meningococcal septic arthritis remains a rare manifestation of invasive meningococcal disease. Strain and age associations identified in this study remain unexplained. Future analyzes including clinical case information may help to explain these findings.
Subject(s)
Arthritis, Infectious , Meningitis, Meningococcal , Meningococcal Infections , Neisseria meningitidis , Adolescent , Adult , Arthritis, Infectious/epidemiology , Child , Humans , Meningitis, Meningococcal/epidemiology , Wales/epidemiologyABSTRACT
Invasive meningococcal disease persists as a fulminant disorder worldwide. Although cases caused by Neisseria meningitidis serogroup X (MenX) occur infrequently, outbreaks have been reported in countries in Africa in recent decades. We report 2 cases of MenX invasive meningococcal disease in São Paulo, Brazil, in 2021 and 2022, during the COVID-19 pandemic.
Subject(s)
COVID-19 , Meningitis, Meningococcal , Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Brazil/epidemiology , Humans , Meningitis, Meningococcal/epidemiology , Meningococcal Infections/epidemiology , PandemicsABSTRACT
Two cases of epidemic situation of serogroup B meningitis in infants in Shandong Province in 2021 were investigated. Samples of cases and their close contacts were collected for isolation, culture and identification of Neisseria meningitides (Nm). The isolates were subjected to multi-locus sequence typing, outer membrane protein porA and fetA genotyping and drug sensitivity test. Two laboratory-confirmed outbreaks of serogroup B meningitis were reported from Yantai city and Linyi city. The indicated cases were infants aged 5 months and 2 months old respectively. They were not vaccinated with meningitis vaccine. Their epidemiological characteristics and clinical manifestations were similar and the prognosis was good. The same sequence type (ST) of serogroup B Nm strains as the indicated cases was detected in the samples of close family contacts, but without subsequent cases. Among them, Yantai strain was were identified as the type ST-8920, belonging to CC4821 clonal complex, and the genotypes of porA and fetA were p1.21-2, 23 and F3-1. Linyi strain was a new type, belonging to CC4821 clonal complex and the genotypes of porA and fetA were p1.20, 23 and F1-91. The above strains were resistant to penicillin, ciprofloxacin, levofloxacin and Chemitrim, and their sensitivity to cephalosporin decreased. Two cases of infant serogroup B epidemic were relatively rare in China, which were different from the epidemiological and pathogenic characteristics of other Nm serogroups in the past.
Subject(s)
Epidemics , Meningitis, Meningococcal , Neisseria meningitidis , Humans , Infant , Meningitis, Meningococcal/epidemiology , Multilocus Sequence Typing , SerogroupABSTRACT
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis (Nm) continues to be a global public health concern. Understanding the prevalence of Nm serogroups in IMD is critical for developing strategies for meningococcal vaccination. We used the keywords "cerebrospinal meningitis", "meningococcal", "Neisseria meningitidis'', "meningococcal meningitis", "serogroup'' and "China'' to search five databases, including PubMed, CNKI, CBM (Chinese BioMedical Literature Database), WanFang and VIP from 2010 to 2020. The age distributions, proportions of Nm serogroups and serogroup changes in IMD were analyzed. A total of 14 studies were included according to PRISMA guidelines. In China, from 2010 to 2020, the highest proportion of Nm in IMD was NmC, with 49.7% (95% CI: 35.8%-63.5%), followed by NmB with 30.2% (95%CI:17.3%-43.0%) and NmW with 23.8% (95%CI: 7.0-40.7%). Before 2014, NmC was the major circulating serogroup, with 59.6% (95% CI: 43.8%-75.4%), followed by NmW with 24.4% (95% CI: 5.9%-42.9%). After 2015, IMD cases caused by NmB were increasing, the proportion of NmB reached to 52.4% (95% CI: 31.8%-73.1%). The age groups of children from 0 to 5 years and from 6 to 10 years represented, respectively, 29.6% (95% CI: 16.8%-42.4%) and 28.9% (95% CI: 12.1%-45.8%) of all IMD cases were reported. In China, NmB, NmC and NmW were the major serogroups causing IMD between 2010 and 2020. Since 2015, the proportion of NmB increased rapidly. The current serogroup distribution in China highlights the need of replacing the meningococcal polysaccharide vaccines that are being used in the National Immunization Program with more appropriate vaccines.
Subject(s)
Meningitis, Meningococcal , Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Child , Humans , Infant, Newborn , Infant , Child, Preschool , Serogroup , Prevalence , Meningococcal Infections/prevention & control , Meningitis, Meningococcal/epidemiology , China/epidemiologyABSTRACT
OBJECTIVE: Invasive meningococcal disease (IMD) is life-threatening and associated with substantial morbidity and mortality. The study aimed to examine the clinical characteristics and hospital-based healthcare resource use and related costs following IMD diagnosis in France. METHODS: Patients admitted to hospitals due to IMD between 2014 and 2016 were selected from the French hospital discharge database (PMSI). Demographics, clinical outcomes and health utilization (HRU) during index hospitalization were described. HRU and costs during the follow-up period were also examined. A generalized linear model was applied to examine 1-year costs after index hospitalization adjusting for age, type of IMD and presence of sequelae at index hospitalization. RESULTS: A total of 1,344 patients were identified. About 30% cases were in children < 5 years old and 25% aged 10-24 years. Majority of patients presented as meningococcal meningitis (59%), 25% as meningococcaemia, and 9% both. The case fatality rate during the index hospitalization was 6%. About 15% of patients had at least one sequela at index hospital discharge. The median length of stay and the median cost of index hospitalization were 9 days and 8,045, respectively. Patients with at least one sequela, with clinical manifestation as both meningitis and meningococcaemia, or aged 25 years and older were statistically significantly associated with higher costs than others. CONCLUSION: IMD is unpredictable and can occur in all ages. The study highlights the severity and high health and economic burdens associated with the disease. The data underlines the importance of prevention against IMD through vaccination.
Subject(s)
Meningitis, Meningococcal , Meningococcal Infections , Sepsis , Child , Child, Preschool , Databases, Factual , Financial Stress , Hospitalization , Humans , Meningitis, Meningococcal/complications , Meningitis, Meningococcal/epidemiology , Meningococcal Infections/complications , Sepsis/complicationsABSTRACT
BACKGROUND: Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health. AIMED: To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019. METHODS: Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed. RESULTS: The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019). CONCLUSIONS: IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.
Subject(s)
Meningitis, Meningococcal , Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis , Aftercare , Child , Chile/epidemiology , Cross-Sectional Studies , Disease Progression , Female , Hospitals, Pediatric , Humans , Infant , Male , Meningitis, Meningococcal/complications , Meningitis, Meningococcal/epidemiology , Meningitis, Meningococcal/microbiology , Meningococcal Infections/complications , Meningococcal Infections/epidemiology , Patient Discharge , Serogroup , VaccinationABSTRACT
Meningococcal disease is caused by Neisseria meningitidis; 13 serogroups have been identified and differentiated from each other through their capsular polysaccharide. Serotypes A, B, C, W, X, and Y are responsible for nearly all infections worldwide. The most common clinical manifestations are meningitis and invasive meningococcal disease, both characterized by high mortality and long-term sequelae. The infection rate is higher in children younger than 1 year and in adolescents, who are frequently asymptomatic carriers. Vaccination is the most effective method of preventing infection and transmission. Currently, both monovalent meningococcal vaccines (against A, B, and C serotypes) and quadrivalent meningococcal vaccines (against serogroups ACYW) are available and recommended according to local epidemiology. The purpose of this article is to describe the meningococcal vaccines and to identify instruments that are useful for reducing transmission and implementing the vaccination coverage. This aim could be reached by switching from the monovalent to the quadrivalent vaccine in the first year of life, increasing vaccine promotion against ACYW serotypes among adolescents, and extending the free offer of the anti-meningococcal B vaccine to teens, co-administering it with others proposed in the same age group. Greater awareness of the severity of the disease and increased health education through web and social networks could represent the best strategies for promoting adhesion and active participation in the vaccination campaign. Finally, the development of a licensed universal meningococcal vaccine should be another important objective.