Abstract
BackgroundTo understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam.MethodsA total of 295 isolates and 2,302 CSFs were tested by a meningococcal species- and serogroup-specific polymerase chain reaction (PCR) assay targeting the Neisseria meningitidis (Nm) ctrA gene. Multi-locus sequence typing (MLST) was performed in Nm gene amplification analysis and incidence rates for meningococcal meningitis were estimated.ResultsAmong 295 isolates tested, 10 specimens from Vietnam were confirmed as serogroup B and all were Sequence Type (ST) 1576 by MLST. Among the 2,032 CSF specimen tested, 284 (14%) were confirmed by PCR (ctrA gene), including 67 (23.6%) from China, 92 (32.4%) from Korea, and 125 (44.0%) from Vietnam. Neonates and infants aged < 6 months of age accounted for more than 50% of Nm-PCR positive CSF. Two CSF specimens from Vietnam were identified as serogroup B using MLST. In addition, 44 specimens underwent sequencing to confirm meningococcal serogroup; of these, 21 (48%) were serogroup C, 12 (27%) were serogroup X, 9 (20%) were serogroup Y and 2 (5%) were serogroup B. The incidence rates of meningococcal meningitis among children < 5 years of age was highest in Vietnam (7.4/100,000 [95% CI, 3.6—15.3] followed by Korea (6.8/100,000 [95% CI, 3.5-13.5] and China (2.1/100,000) [95% CI, 0.7-6.2]).ConclusionsThese results suggest that there is a previously undetected, yet substantial burden of meningococcal meningitis among infants and young children. Standardized, sensitive and specific molecular diagnostic assays with Nm serogrouping capacity are needed throughout Asia to understand the true burden of N. meningitidis disease.
Highlights
To understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam
Among 295 bacterial isolates, 10 isolates in Vietnam were confirmed as N. meningitidis
Based on the combined testing of CSFs by bacterial culture and polymerase chain reaction (PCR), this study demonstrated that 75.6% of the children identified with N. meningitidis in CSF were less than 2 years of age: this occurred among infants less than 6 months of age and even in neonates
Summary
To understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam. In Africa, N. meningitidis is the leading cause of severe, life-threatening meningitis and is responsible for thousands of cases and scores of deaths across sub-Saharan “meningitis belt” countries [4,5,6,7]. In Asia, meningitis outbreaks have been reported in child-care settings, schools, college dormitories, military camps, and among returning Hajj pilgrims [8,10,12,13,14,15]. Despite these reports documenting sporadic and epidemic meningococcal disease, there are large gaps in our knowledge of meningococcal disease patterns across large populations of Asia. Through the application of molecular analyses, we provide new evidence of meningococcal meningitis among hospitalized children < 5 years of age who were identified during prospective, population-based surveillance in China, South Korea, and Vietnam
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