Nasopharyngeal Meningococcal Carriage among Children and Adolescents in Turkey in 2018: An Unexpected High Serogroup X Carriage.

Mahmut Can Kızıl ,Mucahit Kaya,Mehmet Ceyhan,Yasemin Balliel,Meda Kondolot,Soner Sertan Kara,Necdet Kuyucu,Adem Karbuz,Zeynep Gökçe Gayretli Aydın ,Zafer Kurugöl ,Ümmühan Çay ,Merve İşeri Nepesov ,Cihangül Bayhan ,Murat Sütçü ,Solmaz Çelebi ,Mustafa Hacımustafaoğlu ,Ener Çağrı Dinleyici ,Ömer Kılıç ,Kürşat Bora Çarman ,Sevliya Öcal Demir

doi:10.3390/children8100871

Abstract

Meningococcal carriage studies and transmission modeling can predict IMD epidemiology and used to define invasive meningococcal disease (IMD) control strategies. In this multicenter study, we aimed to evaluate the prevalence of nasopharyngeal Neisseria meningitidis (Nm) carriage, serogroup distribution, and related risk factors in Turkey. Nasopharyngeal samples were collected from a total of 1267 children and adolescents and were tested with rt-PCR. Nm carriage was detected in 96 participants (7.5%, 95% CI 6.1–9.0), with the peak age at 13 years (12.5%). Regarding age groups, Nm carriage rate was 7% in the 0–5 age group, was 6.9%in the 6–10 age group, was 7.9% in the 11–14 age group, and was 9.3% in the 15–18 age group. There was no statistically significant difference between the groups (p > 0.05). The serogroup distribution was as follows: 25% MenX, 9.4% MenA, 9.4% MenB, 2.1% MenC, 3.1% MenW, 2.1% for MenY, and 48.9% for non-groupable. The Nm carriage rate was higher in children with previous upper respiratory tract infections and with a high number of household members, whereas it was lower in children with antibiotic use in the last month (p < 0.05 for all). In this study, MenX is the predominant carriage strain. The geographical distribution of Nm strains varies, but serogroup distribution in the same country might change in a matter of years. Adequate surveillance and/or a proper carriage study is paramount for accurate/dynamic serogroup distribution and the impact of the proposed vaccination.

Highlights

Invasive meningococcal disease (IMD) caused by Neisseria meningitidis (Nm) is rare, yet it represents a worldwide public health issue
When we compare the matched age groups, in 2015, the carriage rate was 5.3% in the 10–14 age group and 5.6% in the 15–18 age group, whereas it was 7.9% and 9.3% in the present study, respectively [15] (Figure 3). In light of these data, it can be said that there has been an increase in Nm carriage during adolescence in Turkey in the past few years, and Nm carriage has been observed in all age groups from 0 to 18 years old
Meningococcal carriage studies have been conducted to determine the prevalence of carriage and serogroup distribution and better understand transmission dynamics and invasive meningococcal disease (IMD) epidemiology and improve vaccination strategies

Summary

Introduction

Invasive meningococcal disease (IMD) caused by Neisseria meningitidis (Nm) is rare, yet it represents a worldwide public health issue. There are 12 known capsular serogroups, with six of them (A–C, W, X, and Y) causing the majority of human illness [1,2,3]. Nm carriage has been linked to age, crowded living conditions, cigarette smoke exposure, a history of respiratory infection, certain adolescent social behavior, and antibiotic use [4,6,7,8,9,10]. While meningococcal colonization is the first stage in the development of IMD, little is known about the risk variables that predict progression from asymptomatic to symptomatic conditions. The causal serogroup, bacterial genomic plasticity, the human immune system, and environmental variables all play a role in the development of IMD from carriage [3]

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