Abstract
During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.
Highlights
This manual summarizes laboratory techniques used in the isolation and identification of Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae from the cerebrospinal fluid and blood of patients with clinical meningitis
Antimicrobial susceptibility testing of these organisms is not addressed in this manual, and readers are referred to special textbooks and manuals
Gram Stain Procedure for cerebrospinal fluid (CSF) (Hucker Modification) A presumptive diagnosis of bacterial meningitis caused by H. influenzae, S. pneumoniae, and N. meningitidis can be made by Gram stain of the CSF sediment or by detection of specific antigens in the CSF by a latex agglutination test
Summary
This manual summarizes laboratory techniques used in the isolation and identification of Neisseria meningitidis (the meningococcus), Streptococcus pneumoniae (the pneumococcus) and Haemophilus influenzae from the cerebrospinal fluid and blood of patients with clinical meningitis. The procedures described here are not new; most have been used for many years. Even though they require an array of laboratory capabilities, these procedures were selected because of their utility, ease of performance, and ability to give reproducible results. The diversity of laboratory capabilities, the availability of materials and supplies, and their cost, were taken into account. In addition to these basic procedures, methods for subtyping and biotyping of these organisms are included for reference laboratories that have the facilities, the trained personnel, and the desire to perform them
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