Incidence Of Meningococcal Disease Research Articles

Management of meningococcal outbreaks: are we using the same language? Comparison of the public health policies between high-income countries with low incidence of meningococcal disease

ABSTRACTBackground: Invasive meningococcal disease (IMD) in high-income countries usually occurs sporadically with low incidence and occasionally as small clusters or outbreaks.The WHO guidelines (GLs) for IMD outbreak applies only to African countries with high endemic incidence. Several high-income countries developed their own GLs on IMD outbreak, and we compare their terminology, classification, definitions, and public health interventions.Methods: National IMD outbreak GLs of the European Union and the Organisation for Economic Co-operation and Development member states were compared. Due to linguistic barriers, 17 out of forty-one countries were selected, and the GLs on the websites of the national health authorities were independently screened by two researchers.Results: National GLs on IMD outbreak were available for 12 countries. All GLs classify IMD outbreak into organization and community based using different terminology (cluster, epidemic, etc.). Two GLs introduce also a third condition of hyperendemic. Definitions, thresholds, and countermeasures vary among countries.Conclusions: Different definitions of organization and community-based outbreaks and countermeasures are expected because of uncertainties about their effectiveness, and differences between countries in health-care systems and public health policy approaches.Nevertheless, variations in terminology, definitions and countermeasures are confusing and reflect the need for an international standardization.

Carriage meningococcal isolates with capsule null locus dominate among high school students in a non-endemic period, Italy, 2012–2013

Meningococcal disease incidence in Italy remains quite low in the overall population except for infants. Within a study on carriage isolates among high school students we aimed to define: i) the prevalence of carriage isolates, ii) the phenotypic and iii) the molecular features of meningococci by Whole Genome Sequencing (WGS).A total of 1697 pharyngeal samples from undergraduate students (age range 14–19 years) were collected from 2012 to 2013 from six larger cities in Italy. One hundred and twenty culture positive meningococci (7%) were analyzed. Carriage isolates were sent to the National Reference Laboratory for invasive meningococcal disease (IMD) for PCR-based serogroup identification, Multilocus Sequence Typing, PorA and FetA typing. Moreover, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were typed. Core genome MLST (cgMLST) was performed on a subsample of 75 carriage isolates.Capsule null locus (cnl) predominated (47%), followed by serogroup B (27%). The antimicrobial susceptibility profile revealed an high prevalence of reduced susceptibility to penicillin G (54%) and a full susceptibility to ceftriaxone, ciprofloxacin and rifampicin. Carriage isolates presented a high genetic diversity: the clonal complexes (ccs) cc1136, cc198 and cc41/44, were the predominant. An high heterogeneity was also observed for PorA and FetA types. The fhbp and nhba genes were identified in all the carriage isolates; only 5% of the carriage isolates presented the nadA gene. The core genome MLST analysis revealed that the majority of the cnl isolates clustered in a distinct group.The evidence gathered during this study provides the estimate of carriage isolates in high school students in a non-epidemic period in Italy that was lower than expected. Moreover, the highest proportion of carriage isolates were cnl and, overall, they were molecular heterogeneous.

Epidemic situation and preventive strategy for meningococcal disease

The incidence of meningococcal disease is generally low globally at present. The epidemics, problems and challenges of meningococcal disease were described in order to provide support for prevention and control of meningococcal disease in China, especially in the areas of disease surveillance, epidemic changes, serogroup witching, vaccines and vaccination strategies and meningococcal group B vaccine development.

Observational Safety Study of Meningococcal Conjugate Vaccine Against Serogroups A, C, W and Y (Menactra) Used in Routine Healthcare Practice for Persons Aged 2 to 55 Years in Russian Federation

Although incidence of invasive meningococcal disease (IMD) in the Russian Federation is low, children younger 15 years of age are significantly affected. Serogroups A, B, and C are frequently implicated. The quadrivalent meningococcal diphtheria toxoid conjugate vaccine (MenACWY-D) is approved in Russia for immunization of individuals 9 months to 55 years of age. Goals . We evaluated the safety of a single dose of MenACWY-D administered to individuals 2–55 years of age in routine clinical practice in the Russian Federation. Materials and Methods . Using diary cards filled by participants or their parents, this prospective multicenter observational study quantified the occurrence of solicited injection site and systemic reactions up to 7 days after vaccination as well as unsolicited non-serious adverse events (AEs), and serious adverse events (SAEs) for 28 days. Results . The systemicrate of solicited injection site and systemic reactions during the 7-day observation period was 52.0% (95% CI: 41.8; 62.2). Rates of solicited injection site reactions and systemic reactions of any severity were 49% (95% CI: 38.9; 59.2) and 20% (95% CI: 12.7; 29.2), respectively. The rate of unsolicited AEs was 9% (95% CI: 4.2; 16.4). Rates of solicited grade 3 injection site and systemic reactions ranged between 1–3% and 0–1%, respectively. There were no unsolicited adverse reactions (ARs), SAEs, or deaths. Conclusions . These findings corroborate those of pre-licensure and post-registration studies and confirm the safety and good tolerability of MenACWY-D when used in routine clinical practice in individuals 2–55 years of age in the Russian Federation.

A meningococcal B vaccine induces cross-protection against gonorrhea.

PurposeNeisseria meningitidis and Neisseria gonorrhoeae share between 80% and 90% of their genetic sequence. Meningococcal serogroup B vaccines based on outer membrane vesicles—such as VA-MENGOC-BC—could cross-protect against gonorrhea. The aim of this study was to analyze the incidence rates of gonorrhea and other sexually transmitted diseases with respect to the use of the VA-MENGOC-BC vaccine.Materials and MethodsHealth statistics between 1970 and 2017 were reviewed and the incidence of meningococcal disease and sexually transmitted diseases (gonorrhea, syphilis, condyloma acuminatum, hepatitis B and human immunodeficiency virus infection) were analyzed during the pre- and post-vaccination periods. Gonorrhea incidence was also analyzed by age groups.ResultsVA-MENGOC-BC was successfully used to control a meningococcal epidemic in Cuba. The strategy to combat the epidemic was carried out in two stages. The first one was a nationwide mass-vaccination campaign from 1989 to 1990, targeting the population at highest-risk aged 3 months to 24 years. During the second stage, begun in 1991, it was included in the Expanded Immunization Program. Gonorrhea incidence increased from 1970 to 1989. However, after the VA-MENGOC-BC massive vaccination campaign a sharp decrease of gonorrhea incidence was observed. It lasted between 1989 and 1993. A second incidence peak was detected in 1995, but it dropped again. Data clearly show a decline in the incidence of gonorrhea following massive vaccination, in contrast with other sexually transmitted diseases. Incidence rates in unvaccinated age groups also decreased, probably due to herd immunity.ConclusionThere is evidence that VA-MENGOC-BC could induce a moderate protection against gonorrhea.

Meningococcal Disease Among College-Aged Young Adults: 2014-2016.

The incidence and relative risk (RR) of meningococcal disease among college students compared with noncollege students aged 18 to 24 years during 2014-2016 were calculated by using data from the National Notifiable Diseases Surveillance System and enhanced meningococcal disease surveillance. Differences in demographic characteristics and clinical features of meningococcal disease cases were assessed. Available meningococcal isolates were characterized by using slide agglutination, polymerase chain reaction, and whole genome sequencing. From 2014 to 2016, 166 cases of meningococcal disease occurred in persons aged 18 to 24 years, with an average annual incidence of 0.17 cases per 100 000 population. Six serogroup B outbreaks were identified on college campuses, accounting for 31.7% of serogroup B cases in college students during this period. The RR of serogroup B meningococcal (MenB) disease in college students versus noncollege students was 3.54 (95% confidence interval: 2.21-5.41), and the RR of serogroups C, W, and Y combined was 0.56 (95% confidence interval: 0.27-1.14). The most common serogroup B clonal complexes identified were CC32/ET-5 and CC41/44 lineage 3. Although the incidence is low, among 18- to 24-year-olds, college students are at an increased risk for sporadic and outbreak-associated MenB disease. Providers, college students, and parents should be aware of the availability of MenB vaccines.

Meningococcal infection: clinical and epidemiological characteristics in modern conditions

The problems of the incidence of meningococcal disease and the epidemiological situation in the world, in the Russian Federation and in the Armed Forces are consecrated. In the past decade, there has been a global decline in the incidence of meningococcal disease, but there is still the possibility of new outbreaks and epidemics. From 1996 to 2016, a decrease in the incidence of meningococcal disease was also noted in Russia. In certain regions of the Russian Federation, an increase in incidence was recorded, which did not affect the general trend. Against this background, the idea was formed that in the coming years, thanks to a favorable epidemiological situation and the possibility of preventing meningococcal infection with the help of a vaccine, it is possible to achieve control of this infection. However, meningococcus showed all the classic properties of variability and fitness. Changes in the structure of circulating serogroups of meningococcus led to the formation of a non-immune layer of the population in the face of increasing pathogenicity of the dominant serogroups. The activity of the epidemic process is indirectly indicated by the high diversity of genetic and serological clonal complexes, serogroups and serotypes of the pathogen. The incidence of meningococcal disease over the past ten years in the Armed Forces of the Russian Federation can be assessed as low, but mortality has high values. The peak incidence was in 2010, but the maximum percentage of mortality was in 2017-18,2%. The increase in mortality from invasive forms of meningococcal infection, on the one hand, is associated with an increase in the total number of sources of this infection, on the other hand, with errors in early diagnosis and, as a consequence, in the incorrect provision of emergency care at the prehospital stage, which recur from year to year and are of a similar nature.

Is primary meningococcal arthritis in children more frequent than we expect? Two pediatric case reports revealed by molecular test

BackgroundPrimary meningococcal arthritis is a rare infectious disease that occurs in less than 3% of meningococcal infections and is characterized by arthritis without meningitis, fever, rash, or hemodynamic instability Barahona [Case Rep Orthop 4696014:2017 ]. There are no validated clinical criteria that can be used for the diagnosis. We present two pediatric cases of atypical presentation of meningococcal disease revealed by molecular tests.Case presentationThe clinical presentation of the two children (6- and 9-years-old) was characterized by signs of arthritis. By Real Time Polymerase Chain Reaction (RT-PCR), we identified N. meningitidis serogroup Y in the joint fluid in both cases. After specific antimicrobial treatment, the clinical conditions of the two patients quickly improved during hospitalization. Conclusions. We believe that the incidence of meningococcal arthritis could be underestimated in those settings where the use of RT-PCR is limited. Clearer data on the incidence of meningococcal disease would help to design specific treatments and the best possible national vaccine strategies [Fiji Sci Rep 23:39784, 2016, J Infect 67:385-90, 2013].

Declining Incidence of Invasive Meningococcal Disease in South Africa: 2003-2016.

Invasive meningococcal disease (IMD) is endemic to South Africa, where vaccine use is negligible. We describe the epidemiology of IMD in South Africa. IMD cases were identified through a national, laboratory-based surveillance program, GERMS-SA, from 2003-2016. Clinical data on outcomes and human immunodeficiency virus (HIV) statuses were available from 26 sentinel hospital sites. We conducted space-time analyses to detect clusters of serogroup-specific IMD cases. Over 14 years, 5249 IMD cases were identified. The incidence was 0.97 cases per 100 000 persons in 2003, peaked at 1.4 cases per 100 000 persons in 2006, and declined to 0.23 cases per 100 000 persons in 2016. Serogroups were confirmed in 3917 (75%) cases: serogroup A was present in 4.7% of cases, B in 23.3%, C in 9.4%; W in 49.5%; Y in 12.3%, X in 0.3%; Z in 0.1% and 0.4% of cases were non-groupable. We identified 8 serogroup-specific, geo-temporal clusters of disease. Isolate susceptibility was 100% to ceftriaxone, 95% to penicillin, and 99.9% to ciprofloxacin. The in-hospital case-fatality rate was 17% (247/1479). Of those tested, 36% (337/947) of IMD cases were HIV-coinfected. The IMD incidence in HIV-infected persons was higher for all age categories, with an age-adjusted relative risk ratio (aRRR) of 2.5 (95% confidence interval [CI] 2.2-2.8; P < .001) from 2012-2016. No patients reported previous meningococcal vaccine exposure. Patients with serogroup W were 3 times more likely to present with severe disease than those with serogroup B (aRRR 2.7, 95% CI 1.1-6.3); HIV coinfection was twice as common with W and Y diseases (aRRR W = 1.8, 95% CI 1.1-2.9; aRRR Y = 1.9, 95% CI 1.0-3.4). In the absence of significant vaccine use, IMD in South Africa decreased by 76% from 2003-2016. HIV was associated with an increased risk of IMD, especially for serogroup W and Y diseases.

The decline of the incidence of meningococcal disease in Barcelona between 1988 and 2015: The influence of the vaccine against serogroup C

Introduction and objectiveThe purpose of this study was to describe the evolution of meningococcal disease (MD) in the city of Barcelona between 1988 and 2015 and to assess the impact of the vaccine against serogroup C. Materials and methodologyThe evolution of MD and by serogroup was analyzed using the information included in the mandatory notification diseases registry. Incidences of all serogroups between the periods of before and after the implementation of the serogroup C vaccine in 2000 were compared. Vaccination coverage among cases, serogroup among vaccinated cases and mortality and case fatality rates were analyzed. ResultsMD has evolved from an incidence rate in children aged under 1 of 63.09 cases per 100,000 in 1997–2000 to 15.44 per 100,000 in 2001–2015. All MD serogroups incidences decreased after the implementation of the vaccine, especially for serogroup C among children aged between 1 and 4. Since 2000 vaccine coverage in MD cases by this serogroup was 7.6% while in those affected by serogroup B it was 35.0% (p<0.01). Among those vaccinated, 66.4% of cases were serogroup B and 5.2% were C (p<0.01). Mortality and case fatality rates were 7.7% and 0.19/100,000 respectively, without significant changes in time regarding case fatality. ConclusionsIncidence caused by serogroups B and C has decreased after the systematic vaccination against serogroup C. Vaccination against serogroup B could further reduce the impact of this lethal disease which has not decreased during this period.

Societal costs due to meningococcal disease: a national registry-based study

PurposeLimited detailed evidence exists on the societal costs of meningococcal disease. The objective of this study was to estimate the average 5-year societal cost of events attributable to meningococcal disease in Denmark.MethodsThe study was based on the nationwide Danish registries. Incident patients diagnosed with meningococcal disease were identified and each matched with two controls, using direct matching on age, gender, and level of education. Siblings constituted a secondary control population where one patient was matched with one sibling control without meningococcal disease. Costs related to health care in the primary and secondary sectors, prescription medicine, municipality home care services and costs of production loss, ie, estimated loss of yearly earnings, were included (1997–2015).ResultsThe incidence of meningococcal disease fluctuated between 1980 and 2015. The average attributable societal costs were highest the first year after diagnosis, with costs equaling USD 18,920 per event in the primary study population (matched controls) and USD 16,169 in the secondary study population (sibling controls). Hospital admission costs accounted for 65% and production loss for 30%; however, having a lifetime perspective and including loss due to premature death further increase the costs of meningococcal disease events.ConclusionThe costs of meningococcal disease are substantial, and the estimated costs of event may be informative in evaluating the impact of preventive interventions targeting meningococcal disease.

Meningococcal Serogroup B Vaccine Immunogenicity in High-Risk Groups: What Are the Implications?

* Abbreviation: 4CMenB — : component Meningococcal B Vaccine (Bexsero) quadrivalent Neisseria meningitidis is an organism that is well-known to pediatricians as an important cause of sepsis, which can be fulminant, and of bacterial meningitis as well as invasive infections at other sites. These infections can lead to hearing loss, loss of limbs, and even death in a matter of hours.1 On the basis of the content of the polysaccharide capsule, N meningitidis can be divided into 12 serogroups, but serogroups A, B, C, D, Y, and W-135 are responsible for virtually all invasive infections. In the United States, the overall incidence of meningococcal disease has been on the decline over the past several decades, which, in part, may be related to the introduction of routine administration of the quadrivalent meningococcal conjugate vaccine directed against serogroups A, C, Y, and W-135 to adolescents.2 Investigators from the Centers for Disease Control and Prevention using data from the National Notifiable Diseases Surveillance System recently reported that the overall average incidence of meningococcal disease was 0.26 cases per 100 000 population over the years 2006–2015.2 This translates into an average annual number of cases of 792 associated with 98 deaths (14.9%). On … Address correspondence to Sheldon L. Kaplan, MD, Department of Pediatrics, Texas Children’s Hospital, Feigin Tower, Suite 1150, 1102 Bates Ave, Houston, TX 77030. E-mail: skaplan{at}bcm.edu

Interconnected clusters of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11), involving bisexuals and men who have sex with men, with discos and gay-venues hotspots of transmission, Tuscany, Italy, 2015 to 2016

In 2015 an increased incidence of invasive meningococcal disease due to serogroup-C (MenC) occurred in Tuscany, Italy. This led the Regional Health Authority of Tuscany to implement a reactive immunisation campaign and to launch an epidemiological field investigation aiming to address targeted immunisation interventions. In 2011–14, 10 MenC cases had been reported compared with 62 cases in 2015–16. The case fatality rate was 21% (n = 13) and 51 cases (82.3%) were confirmed as C:P1.5–1,10–8:F3–6:ST-11(cc11). Overall, 17 clusters were recognised. Six discos and four gay-venues were found to have a role as transmission-hotspots, having been attended by 20 and 14 cases in the 10 days before symptoms onset. Ten and three cases occurred, respectively, among men who have sex with men (MSM) and bisexual individuals, who were involved in 11 clusters. In addition, heterosexual cases (n = 5) attending gay-venues were also found. Secondary cases were not identified. Molecular typing indicated close relationship with MenC clusters recently described among gay, bisexual and other MSM in Europe and the United States, suggesting a possible international spread of the serogroup-C-variant P1.5–1,10–8:F3–6:ST-11(cc11) in this population-group; however, epidemiological links were not identified. In December 2016, a targeted vaccination campaign involving discos and lesbian, gay, bisexual, and transgender (LGBT) associations was implemented. During 2017, 10 cases of MenC occurred, compared with 32 and 30 cases reported in 2015 and 2016 respectively, suggesting the effectiveness of the reactive and targeted immunisation programmes.

Meningococcal carriage in the European Union from 2007–2016: A systematic review and meta-analysis

Introduction Despite an overall decrease in the incidence of meningococcal disease within the European Union (EU) in recent years, it continues to be a public health concern due to the disease severity, outbreak potential, and peaks in incidence among infants and adolescents. Since pharyngeal carriage of meningococcal disease is the primary means of disease transmission, it is important to compare carriage data to disease data from the same region to inform future vaccination policy. We aim to characterize the recent state of meningococcal carriage within the EU by reviewing the prominent serogroups associated with pharyngeal carriage. Methods We conducted a systematic review of the literature and relevant conference abstracts to identify studies reporting on serogroup-specific meningococcal carriage among age groups and in high-risk settings (military, university, and Hajj) for 2007–2016. Additional data were requested from authors of meningococcal carriage studies in specific age groups to standardize age ranges. These data were then used to conduct age-specific meta-analyses to elucidate serogroup-specific carriage in various age groups. Independent random effects meta-analyses were conducted for key serogroups—A, B, C, W, X, and Y—using the Freeman–Tukey transformation and exact binominal confidence intervals. For studies not eligible for meta-analysis, a narrative synthesis was performed. Results In total, 15 studies of the 4965 identified met our inclusion criteria and reported carriage data among military personnel (N = 3), university students (N = 6), and/or defined age groups (N = 12) from EU countries. No study reported serogroup-specific carriage among Hajj/Umrah pilgrims. Overall carriage rates in military personnel were higher among new recruits in Greece (15.2%) than in professional soldiers in Poland (5.2–5.7%). Serogroups B (range: 1.6–6.8%) and Y (range: 0.5–1.4%) were the most prevalent serogroups in all military studies. Among university studies, overall carriage ranged from 10.4% in Greece in 2015 to 62% in England in 2009. Serogroups B, W, and Y were the most common key serogroups identified. Overall carriage rates in defined age groups were lowest among 10–12-year olds in England at approximately 3% and highest among studies from university-aged students (range: 13–62%). No studies were conducted among older adults. Data from eight studies were included in the meta-analyses. Four studies reported data among 11- to 17-year-olds (England N = 1, Italy N = 2, France N = 1), and seven among 18- to 24-year-olds (England N = 3, Italy N = 2, France N = 1, Portugal N = 1). In 11- to 17-year-olds, among key serogroups, serogroup B was most prevalent (1.92%, 95% CI: 1.26–2.71). The remaining key serogroups in this age group each had a prevalence of Conclusions The primary serogroups identified in the age groups responsible for transmission correspond to those with higher incidence within the EU: serogroups B and Y with W increasing in recent years. Surveillance of invasive disease and carriage studies should continue, especially in light of the introduction of new vaccines within many countries’ national immunization schedules. Since conjugate vaccines for serogroups A, C, W, and Y have been shown to induce herd immunity and decrease carriage for serogroups A and C, the national vaccine strategies targeting age groups at highest risk for carriage acquisition and transmission could further reduce the overall burden of disease. Additional studies are required to understand the impact of new meningococcal serogroup B vaccines on carriage and their breadth of protection against disease.

Epidemiology of Meningococcal Disease Outbreaks in the United States, 2009-2013.

Although the incidence of meningococcal disease is low in the United States, outbreaks remain a serious public health concern. In this evaluation, we identify and describe outbreaks of meningococcal disease. A retrospective review of all meningococcal disease cases reported from 1 January 2009 to 31 December 2013 was performed by state health departments and the Centers for Disease Control and Prevention to identify meningococcal disease outbreaks. An outbreak was defined as ≥2 primary cases of the same serogroup within <3 months in an organization, or a ≥2-fold increase in disease rates in a community. From 2009 to 2013, a total of 3686 cases of meningococcal disease were reported in the United States. Among these, 180 primary cases (4.9%) occurred as part of 36 outbreaks (17 organization-based and 19 community-based). Serogroup B accounted for 8 (47.1%) of the organization-based outbreaks, including 6 of 8 university outbreaks. Serogroup C accounted for 10 (52.6%) of the community-based outbreaks, including both of 2 outbreaks identified among men who have sex with men. Organization- and community-based outbreaks differed in predominant serogroup, age distribution of cases, and clinical syndrome. Among 33 outbreaks with known information, a vaccination and/or expanded chemoprophylaxis campaign was conducted in 16 (48.5%). Outbreak-associated cases account for approximately 5% of all meningococcal disease cases in the United States. Serogroup B is the primary cause of organization-based outbreaks, with the majority of university outbreaks due to serogroup B, and serogroup C is the primary cause of community-based outbreaks.

Epidemiology of vaccine-preventable diseases in Japan: considerations for pre-travel advice for the 2019 Rugby World Cup and 2020 Summer Olympic and Paralympic Games.

IntroductionIn 2019 and 2020, Japan will host two international sporting events estimated to draw a combined 22 million visitors. Mass gatherings like these ones increase the risk of spread of infectious disease outbreaks and international transmission. Pre-travel advice reduces that risk.MethodsTo assist ministries of health and related organizations in developing pre-travel advice, we summarized national surveillance data in Japan (2000–2016, to the extent available) for rubella, invasive pneumococcal disease, measles, non-A and non-E viral hepatitis, hepatitis A, invasive Haemophilus influenzae disease, tetanus, typhoid fever, invasive meningococcal disease, Japanese encephalitis, influenza, varicella, mumps and pertussis by calculating descriptive statistics of reported cases and reviewing trends. (See Annex A for details of reviewed diseases.)ResultsOur findings showed notable incidences of rubella (1.78 per 100 000 person-years), influenza (243.5 cases per sentinel site), and mumps (40.1 per sentinel site); seasonal increases for influenza (November–May) and Japanese encephalitis (August–November); and a geographical concentration of Japanese encephalitis in western Japan. Measles cases decreased from 11 013 in 2008 to 35 in 2015, but outbreaks (n = 165 cases) associated with importation occurred in 2016. Though invasive meningococcal disease incidence was only 0.03 per 100 000, international transmission occurred at a mass gathering in Japan in 2015.DiscussionMinistries of health and related organizations should use these findings to develop targeted pre-travel advice for travellers to the 2019 Rugby World Cup and the 2020 Summer Olympic and Paralympic Games, especially for mumps, measles, rubella, influenza, and meningitis. Travellers with increased exposure risk should also be advised about hepatitis A and Japanese encephalitis.

The threat of meningococcal disease during the Hajj and Umrah mass gatherings: A comprehensive review.

The Hajj and Umrah mass gatherings represent many of the risk factors for meningococcal disease and have historically been associated with both local and international outbreaks of the disease. The implementation of strict preventative measures including mandatory meningococcal vaccination with the quadrivalent (A,C,Y,W) vaccine has prevented pilgrimage-associated meningococcal outbreaks and significantly reduced the incidence of the disease at these events. However, meningococcal disease remains an important public health threat at the Hajj and Umrah due in part to the evolving nature of the disease, characterized with diverse and varying geographic trends, fluctuations in incidence and shifts in serogroups and genotypes. In addition, the current Hajj and Umrah meningococcal disease preventative measure do not protect against all invasive serogroups and do not necessarily affect carriage and transmission as the polysaccharide vaccine is still widely used. As a consequence, these events are still susceptible to outbreaks of the disease including those due to serogroups not included in the required vaccines such as serogroups B and X. In this context, despite the global decline in incidence of meningococcal disease, including that cause by serogroup B, the increased predominance of serogroup B disease in many countries, including countries with large Muslim populations, and the emergence of serogroup X in the African meningitis belt, are particularly concerning. Continued and strict surveillance of meningococcal diseases nationally and globally, especially in Muslim countries, is essential in detecting, understanding, and predicting the changes in the epidemiology of the disease and informing appropriate prevention and control strategies during these events. The current meningococcal disease preventative measures for Hajj and Umrah should continue to be strictly implemented, reviewed regularly and updated in accordance with changes in the epidemiology of meningococcal disease and availability of new preventative tools including new vaccines.

Impact of meningococcal C conjugate vaccination programs with and without catch-up campaigns in adolescents: Lessons learned from Bahia, Brazil

ABSTRACTThe significant increase in the incidence rates and ongoing outbreaks of serogroup C meningococcal (MenC) disease, associated with the sequence type-103 complex, motivated the incorporation of the meningococcal C conjugate (MCC) vaccine in the routine immunization program in the State of Bahia, Brazil in early 2010, targeting children younger than 5 years of age. In its capital, Salvador, the program also included a catch-up campaign for individuals 10–24 years of age. We performed an observational, ecological study, analyzing data collected from 2007 to 2015, to compare the impact of these two immunization strategies on meningococcal disease incidence and mortality rates.In Salvador, following the vaccination program, a dramatic early impact on MenC disease and mortality rates could be observed, with significant reductions in incidence rates of MenC disease in all age groups, including individuals that were too old to have been vaccinated, indicating the presence of herd protection. Compared to the pre-vaccine period, a virtual disappearance of MenC disease was observed in 2015. However, in the state of Bahia (excluding the city of Salvador), no herd protection could be observed, with significant impact only among vaccine-eligible children within 5 years of introduction of the MCC vaccination program.These results highlight the importance of catch-up campaigns, including adolescents and young adults, to induce herd protection compared to immunization strategies restricted to infants and young children. This information is crucial for identifying optimal immunization policies and future strategies, focused on adolescents, to optimize the impact of MCC vaccination programs.

Current Epidemiology and Trends in Meningococcal Disease-United States, 1996-2015.

In 2005, meningococcal conjugate vaccine (MenACWY) was recommended for routine use among adolescents aged 11-18 years. This report describes the epidemiologic features of meningococcal disease and trends in meningococcal disease incidence following MenACWY introduction in the United States. Incidence rates and case-fatality ratios by age group and serogroup during 2006-2015 were calculated using data from the National Notifiable Diseases Surveillance System (NNDSS); changes in incidence during this time were evaluated. Additionally, 20-year trends (1996-2015) in age- and race-standardized incidence were examined using data from Active Bacterial Core surveillance (ABCs). During the years 2006-2015, 7924 cases of meningococcal disease were reported to NNDSS, resulting in an average annual incidence of 0.26 cases per 100000 population; 14.9% of cases were fatal. Among cases with serogroup information, 2290 (35.8%) were serogroup B, 1827 (28.5%) were serogroup Y, 1457 (22.8%) were serogroup C, 436 (6.8%) were serogroup W, and 392 (6.1%) were other serogroups. The incidence of serogroups A, C, W, and Y combined declined 76% among persons aged 11-20 years from 2006-2010 to 2011-2015 (P < .0001). From 1996 through 2015, the incidence of meningococcal disease declined among all age groups and predominant serogroups. Declines in meningococcal disease incidence in the United States have been observed among all age groups and predominant serogroups (B, C, and Y). Reductions in the incidence of meningococcal disease due to serogroups A, C, W, and Y among adolescents suggest an impact of the MenACWY vaccine program in this age group.

Recommendations for the use of meningococcal vaccines in South Africa

Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa. Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia. The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningococcal vaccine is preferable to the polysaccharide vaccine given the ability of the protein-conjugated meningococcal vaccine to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.