Abstract
Carriage of Neisseria meningitidis, the meningococcus, is a prerequisite for invasive meningococcal disease (IMD), a potentially devastating infection that disproportionately afflicts infants and children. Humans are the sole known reservoir for the meningococcus, and it is carried asymptomatically in the nasopharynx of ~10% of the population. Rates of carriage are dependent on age of the host and social and behavioural factors. In the UK, meningococcal carriage has been studied through large, multi-centre carriage surveys of adolescents in 1999, 2000, and 2001, demonstrating carriage can be affected by immunisation with the capsular group C meningococcal conjugate vaccine, inducing population immunity against carriage. Fifteen years after these surveys were carried out, invasive meningococcal disease incidence had declined from a peak in 1999. The UKMenCar4 study was conducted in 2014/15 to investigate rates of carriage amongst the adolescent population during a period of low disease incidence. The protocols and methodology used to perform UKMenCar4, a large carriage survey, are described here.
Highlights
Asymptomatic oropharyngeal carriage of the Gram negative diplococcus Neisseria meningitidis occurs at a variable rate, with a range of approximately 2% to 30%, dependent on age and exposure to risk factors1
Historically high invasive meningococcal disease (IMD) incidence in the meningitis belt in Africa, led to carriage studies10 performed by the MenAfriCar consortium in association with the introduction of the conjugate polysaccharide A vaccine in 2010
Three large multi-centre carriage surveys conducted through the UK Meningococcal Carriage (UKMenCar) consortium, UKMenCar1-3, were carried out in 1999, 2000, and 2001
Summary
Asymptomatic oropharyngeal carriage of the Gram negative diplococcus Neisseria meningitidis occurs at a variable rate, with a range of approximately 2% to 30%, dependent on age and exposure to risk factors. Three large multi-centre carriage surveys conducted through the UK Meningococcal Carriage (UKMenCar) consortium, UKMenCar, were carried out in 1999, 2000, and 2001 These surveys assessed oropharyngeal carriage of meningococci and collected risk factor data in over 45,000 adolescents in the UK; and demonstrated that the population immunity induced by the MCC vaccine programme was due to the reduction in carriage of the specific hypervirulent strain C:cc1124,25. Study objectives The specific objective was to characterise the Neisseria species obtained as part of the UKMenCar study, which sampled 21,873 adolescents aged 15–19 years attending educational establishments in eleven sampling sites around the UK between September 2014 and March 2015 These isolates were characterized phenotypically and genotypically in order to:. The tutorials explored the basis of decisions on immunisation and the different conclusions that different individuals might make from the same information
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