Meningitis Vaccination, Knowledge, and Awareness Among YMSM in Chicago.

Serogroup C invasive meningococcal disease (IMD) outbreaks in men who have sex with men (MSM) have been occurring with greater frequency in urban areas across the United States. An effective vaccine for IMD is available and is recommended for MSM in outbreak settings. Particular subgroups of MSM have been disproportionately represented in outbreaks, specifically young, Black, and HIV-positive MSM. As little is known about the knowledge, awareness, and vaccination status of young MSM, we sought to describe this and explore racial/ethnic differences. Data were collected from an established cohort study-RADAR-of 16- to 29-year-old MSM recruited through previous cohort studies and/or by being a partner or peer of a current study member. A total of 486 young MSM (YMSM) responded to 13 IMD-related questions. Approximately half of the sample correctly identified how IMD is spread and 58.6% accurately responded that vaccination was the best prevention method; however, more than 60% of participants felt they were at no risk of getting meningitis and only 49% self-reported vaccination. Additionally, White YMSM were significantly more likely to be vaccinated and to have accurate knowledge and risk perception of IMD compared with Black YMSM. Findings have important implications for disease control, outbreak management, and intervention development.

On the trail of preventing meningococcal disease: a survey of students planning to travel to the United States.

BACKGROUND: College freshmen living in dormitories are at increased risk for meningococcal disease. Many students become a high-risk population when they travel to the United States. This study surveyed the knowledge, attitudes toward, and behavior surrounding the disease among Taiwanese college students planning to study in the United States, and to identify factors that may affect willingness to accept meningococcal vaccination. METHODS: A cross-sectional survey of college students going to study in the United States was conducted in a medical center-based travel medicine clinic. Background information, attitudes, general knowledge, preventive or postexposure management, and individual preventive practices were collected through a structured questionnaire. RESULTS: A total of 358 students were included in the final analysis. More than 90% of participants believed that preventing meningococcal disease was important. However, fewer than 50% of students accurately answered six of nine questions exploring knowledge of the disease, and only 17.3% of students knew the correct management strategy after close contact with patients. Logistic regression analysis showed that students who understood the mode of transmission (odds ratio: 3.21, 95% CI = 1.117-9.229), medication management (1.88, 1.045-3.38), and epidemiology (2.735, 1.478-5.061) tended to be vaccinated. CONCLUSIONS: Despite an overall positive attitude toward meningococcal vaccination, there was poor knowledge about meningococcal disease. Promoting education on the mode of transmission, epidemiology, and pharmacological management of the disease could increase vaccination rates. Both the governments and travel medicine specialists should work together on developing an education program for this high-risk group other than just requiring vaccination.

Long-term mortality in patients diagnosed with meningococcal disease: a Danish nationwide cohort study.

BACKGROUND: In contrast to the case fatality rate of patients diagnosed with meningococcal disease (MD) the long-term mortality in these patients is poorly documented. METHODOLOGY/PRINCIPAL FINDINGS: We performed a nationwide, population-based cohort study including all Danish patients diagnosed with MD from 1977 through 2006 and alive one year after diagnosis. Data was retrieved from the Danish National Hospital Register, the Danish Civil Registration System and the Danish Register of Causes of Death. For each patient four age- and gender-matched individuals were identified from the population cohort. The siblings of the MD patients and of the individuals from the population cohort were identified. We constructed Kaplan-Meier survival curves and used Cox regression analysis, cumulative incidence function and subdistribution hazard regression to estimate mortality rate ratios (MRR) and analyze causes of death. We identified 4,909 MD patients, 19,636 individuals from the population cohort, 8,126 siblings of MD patients and 31,140 siblings of the individuals from the population cohort. The overall MRR for MD patients was 1.27 (95% confidence interval (CI), 1.12-1.45), adjusted MRR, 1.21 (95% CI, 1.06-1.37). MD was associated with increased risk of death due to nervous system diseases (MRR 3.57 (95% CI, 1.82-7.00). No increased mortality due to infections, neoplasms or cardiovascular diseases was observed. The MRR for siblings of MD patients compared with siblings of the individuals from the population cohort was 1.17 (95% CI, 0.92-1.48). CONCLUSIONS: Patients surviving the acute phase of MD have increased long-term mortality, but the excess risk of death is small and stems mainly from nervous system diseases.

The strategy to control New Zealand's epidemic of group B meningococcal disease.

BACKGROUND: In New Zealand today, babies of Pacific ethnicity born in South Auckland have a 1-in-48 chance of contracting meningococcal disease by the time they are 5 years of age. METHODS: The New Zealand government, Chiron Vaccines and the University of Auckland have collaborated to develop and investigate a group B meningococcal vaccine to allow a mass-immunization program to control a prolonged and intense epidemic. Within 3 years, a strain-specific meningococcal outer membrane vesicle vaccine has been developed, and overlapping clinical trials have been undertaken; a report was submitted for regulatory approval within 2 years. An important aspect of the project's strategy was to apply, with physicochemical data, the results of the New Zealand outer membrane vesicle vaccine trials to the parent vaccine produced and evaluated by the Norwegian National Institute of Public Health. Immunogenicity results for the New Zealand vaccine are promising, with the vaccine showing a reactogenicity profile similar to that of the parent vaccine. CONCLUSIONS: Controlling the epidemic depends on delivering an effective vaccine to the individuals at greatest risk, ie, mainly Maori and Pacific populations that previous health programs have struggled to reach. Participation of and partnership with these communities in public health decision-making and vaccine delivery will be critical to a successful immunization program.

Carriage of Neisseria meningitidis among household contacts of patients with meningococcal disease in New Zealand.

The aims of this study were to estimate carriage prevalence, identify factors predictive of carriage, and compare strains of Neisseria meningitidis isolated from patients with meningococcal disease and their household contacts. A total of 954 contacts of 160 patients had a nasopharyngeal swab and an interview relating to factors associated with carriage. The carriage prevalence was 20.4% for Neisseria meningitidis, 11.3% for serogroup B, and 2.6% for serogroup C. Age-standardised carriage was higher in Maori (36.8%) than in Pacific Island (21.5%) or European/other (11.1%) ethnic groups. Factors associated with carriage were smoking, with personal smokers (odds ratio [OR] 2.5) and passive smokers (OR 1.6) having a higher carriage risk than those in smoke-free houses; ethnicity, with Maoris having a higher carriage risk than those of non-Maori or non-Pacific Island ethnicity (OR 2.2); gender, with males at higher risk than females (OR 1.7); and age, with 0-4-year-olds less likely and 15-24-year-olds more likely to be carriers than those over 25 years. Strong patient-contact clustering by meningococcal strain (chi-square1 = 16.7, P=0.00004) suggested an important role for the household setting in transmission. The low carriage prevalence of serogroup B Neisseria meningitidis among household contacts may reflect its low transmissibility but high virulence. No direct relationship was found between prevalence of ethnic-specific carriage and the incidence of meningococcal disease.

Meningococcal disease in Australia; looking at the past, thinking of the future.

In 1987 an unexpected change in the epidemiology of meningococcal disease began in Australia. The change was accompanied by an outbreak of serogroup A meningococcal disease among Aboriginal central Australians, and was followed by a progressive rise in notifications of disease caused by both serogroup B and C nationwide. Over the last 4 years, the notification rate has plateaued at 2.1-2.3 per 100,000 population. Virulent clonal groups of serogroup A and C meningococci that have caused outbreaks appear to be identical to strains that have caused large outbreaks in other countries. We cannot predict where and when the next outbreak will occur. However, we can plan to respond swiftly when it does. This report presents an overview of the observed trends, the association between the microbiology and epidemiology of meningococcal disease, and the relevance of this association to outbreaks, with recommendations for management.

[Meningococcal disease in western Galilee].

79 patients with meningococcal disease were evaluated retrospectively between 1972-1986. All the neisseria isolated were sensitive to penicillin but resistant to sulphonamides. Most of the infections (54%) were caused by serogroup B strains. Clinical features included fever (98%), vomiting (65%), and headache (60%). Purpura appeared in 95% and severe neurological features in 25%. Most patients (83%) were children less than 10 years old. The incidence was 1.4/100,000 in the non-Jewish population and 2.3/100,000 in the Jewish population. The overall mortality was 23%, but about 50% in the Jewish population (10 deaths in 18 cases). In kibbutzim the incidence (7.5/100,000) and mortality were especially high. The need for awareness of the disease and the importance of early diagnosis and aggressive treatment are emphasized.

[The heterogeneity of formed collectives in susceptibility to meningococcal adhesion]. / O geterogennosti formiruemykh kollektivov po vospriimchivosti k adgezii meningokokkov.

4 patients with meningococcal infection and 141 meningococcal carriers were examined. The authors study heterogeneity of human population concerning susceptibility or stability of erythrocytes to adhesive influence of meningococci. In 17.4% of cases erythrocytes were highly susceptible to adhesion of meningococci, in 20.4% were stable to this influence, in 62.2% were moderately susceptible. The highest susceptibility of erythrocytes (out of statistics) was marked at the patients of Kirghiz and Tadjik nationalities. These indexes have the same statistic frequency for the persons with different blood groups (system ABO), independently of their rural or urban place of residence. The high susceptibility of erythrocytes (0.25 GAE or less) to adhesion of meningococci is three times more frequent among the persons with meningococcal infection and carriers of meningococcus. This connection may be regarded as a predisposition of the organism for the infection. Thus, the susceptibility of erythrocytes to adhesion of meningococci gives the possibility to determine the persons who need an urgent immunization at the forming collectives.