Meningococcal Research Articles

Genomic oropharyngeal Neisseria surveillance detects MALDI-TOF MS species misidentifications and reveals a novel Neisseria cinerea clade.

Introduction. Commensal Neisseria spp. are highly prevalent in the oropharynx as part of the healthy microbiome. N. meningitidis can colonise the oropharynx too from where it can cause invasive meningococcal disease. To identify N. meningitidis, clinical microbiology laboratories often rely on Matrix Assisted Laser Desorption/Ionisation Time of Flight Mass Spectrometry (MALDI-TOF MS).Hypothesis/Gap statement. N. meningitidis may be misidentified by MALDI-TOF MS.Aim. To conduct genomic surveillance of oropharyngeal Neisseria spp. in order to: (i) verify MALDI-TOF MS species identification, and (ii) characterize commensal Neisseria spp. genomes.Methodology. We analysed whole genome sequence (WGS) data from 119 Neisseria spp. isolates from a surveillance programme for oropharyngeal Neisseria spp. in Belgium. Different species identification methods were compared: (i) MALDI-TOF MS, (ii) Ribosomal Multilocus Sequence Typing (rMLST) and (iii) rplF gene species identification. WGS data were used to further characterize Neisseria species found with supplementary analyses of Neisseria cinerea genomes.Results. Based on genomic species identification, isolates from the oropharyngeal Neisseria surveilence study were composed of the following species: N. meningitidis (n=23), N. subflava (n=61), N. mucosa (n=15), N. oralis (n=8), N. cinerea (n=5), N. elongata (n=3), N. lactamica (n=2), N. bacilliformis (n=1) and N. polysaccharea (n=1). Of these 119 isolates, four isolates identified as N. meningitidis (n=3) and N. subflava (n=1) by MALDI-TOF MS, were determined to be N. polysaccharea (n=1), N. cinerea (n=2) and N. mucosa (n=1) by rMLST. Phylogenetic analyses revealed that N. cinerea isolates from the general population (n=3, cluster one) were distinct from those obtained from men who have sex with men (MSM, n=2, cluster two). The latter contained genomes misidentified as N. meningitidis using MALDI-TOF MS. These two N. cinerea clusters persisted after the inclusion of published N. cinerea WGS (n=42). Both N. cinerea clusters were further defined through pangenome and Average Nucleotide Identity (ANI) analyses.Conclusion. This study provides insights into the importance of genomic genus-wide Neisseria surveillance studies to improve the characterization and identification of the Neisseria genus.

Effectiveness of MenB-4C vaccine against gonorrhea: a systematic review and meta-analysis.

There is no licensed vaccine against gonorrhea but Neisseria meningitidis serogroup B outer membrane vesicle-based vaccines, like MenB-4C, may offer cross-protection against gonorrhea. This systematic review and meta-analysis synthesized the published literature on MenB-4C vaccine effectiveness against gonorrhea. We conducted a literature search of electronic databases (PubMed, Medline, Embase, Global Health, Scopus, Google Scholar, CINAHL, and Cochrane Library) to identify peer-reviewed papers, published in English, from 1/1/2013-7/12/2024 that reported MenB-4C vaccine effectiveness estimates against gonorrhea and gonorrhea/chlamydia co-infection, and the duration of MenB-4C vaccine-induced protection. We estimated pooled MenB-4C vaccine effectiveness (≥1 dose) against gonorrhea using the DerSimonian-Laird random effects model. Eight papers met our eligibility criteria. Receipt of ≥1 dose of MenB-4C vaccine was 23%-47% effective against gonorrhea. Two doses of MenB-4C vaccine were 33-40% effective against gonorrhea and one dose of MenB-4C vaccine was 26% effective. MenB-4C vaccine effectiveness against gonorrhea/chlamydia co-infection was mixed with two studies reporting effectiveness estimates of 32% and 44%, and two other studies showing no protective effect. MenB-4C vaccine effectiveness against gonorrhea was comparable in people living with HIV (44%) and people not living with HIV (23%-47%). Pooled MenB-4C vaccine effectiveness (≥1 dose) against gonorrhea was 32.4%. One study concluded that MenB-4C vaccine effectiveness against gonorrhea may wane approximately 36 months post-vaccination. MenB-4C vaccine is moderately effective against gonorrhea in various populations. Prospective clinical trials that assess the efficacy of MenB-4C against gonorrhea, gonorrhea/chlamydia co-infection, and duration of protection are warranted to strengthen this evidence.

Implementing a meningococcal B vaccination multimedia educational campaign for university students

BackgroundMeningococcal serogroup B (MenB) is the leading cause of potentially fatal meningococcal disease among U.S. older adolescents and young adults; college students are at increased risk. Although the Advisory Committee on Immunization Practices recommends that healthy 16- to 23-year-olds may be vaccinated against MenB, MenB vaccination coverage is low. ObjectiveThis study investigated the impact of a comprehensive multimedia MenB vaccine educational campaign on 2-dose MenB vaccine series initiation among college students. MethodsWe implemented a 6-week-long (October 11, 2021-November 19, 2021) educational intervention via a prospective trial on a university campus (the intervention campus), including video broadcasting, student-led campus programming, and printed materials. The control campus was a different university in the same urban setting. ResultsDuring baseline period 1 (August 26, 2019-November 15, 2019), 2 students on the intervention campus and 3 students on the control campus initiated the MenB vaccination series; 1 student initiated the series on the intervention campus during baseline period 2 (August 27, 2021-October 8, 2021). At least 83 students were exposed to the campaign during the intervention period (October 11, 2021-November 19, 2021). No students initiated the MenB vaccination series during the intervention period, although 1 student completed the vaccination series. ConclusionThe campaign did not influence MenB vaccination initiation on the university campus.

A DAMP-Based Assay for Rapid and Affordable Diagnosis of Bacterial Meningitis Agents: Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae.

The rapid and accurate diagnosis of meningitis is critical for preventing severe complications and fatalities. This study addresses the need for accessible diagnostics in the absence of specialized equipment by developing a novel diagnostic assay. The assay utilizes dual-priming isothermal amplification (DAMP) with unique internal primers to significantly reduce non-specificity. For fluorescence detection, the dye was selected among Brilliant Green, Thioflavin T, and dsGreen. Brilliant Green is preferred for this assay due to its availability, high fluorescence level, and optimal sample-to-background (S/B) ratio. The assay was developed for the detection of the primary causative agents of meningitis (Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae), and tested on clinical samples. The developed method demonstrated high specificity, no false positives, sensitivity comparable to that of loop-mediated isothermal amplification (LAMP), and a high S/B ratio. This versatile assay can be utilized as a standalone test or an integrated assay into point-of-care systems for rapid and reliable pathogen detection.

Subdural Empyema as a Rare Complication Caused by Neisseria meningitidis B

Subdural empyema (SDE) is an intracranial collection of purulent material located between the dura and the arachnoid mater. It is a serious central nervous system infection which can cause neurological sequelae and high mortality. We report one of the rare cases of SDE secondary to Neisseria meningitidis to underline the interest of evoking this diagnosis especially in patients not responding to standard antimicrobial therapy.

Rational modification of Neisseria meningitidis β1,3-N-acetylglucosaminyltransferase for lacto-N-neotetraose synthesis with reduced long-chain derivatives

Lacto-N-neotetraose (LNnT), as a neutral core structure within human milk oligosaccharides (HMOs), has garnered widespread attention due to its exceptional physiological functions. In the process of LNnT synthesis using cellular factory approaches, substrate promiscuity of glycosyltransferases leads to the production of longer oligosaccharide derivatives. Here, rational modification of β1,3-N-acetylglucosaminyltransferase from Neisseria meningitidis (LgtA) effectively decreased the concentration of long-chain LNnT derivatives. Specifically, the optimal β1,4-galactosyltransferase (β1,4-GalT) was selected from seven known candidates, enabling the efficient synthesis of LNnT in Escherichia coli BL21(DE3). Furthermore, the influence of lactose concentration on the distribution patterns of LNnT and its longer derivatives was investigated. The modification of LgtA was conducted with computational assistance, involving alanine scanning based on molecular docking to identify the substrate binding pocket and implementing large steric hindrance on crucial amino acids to obstruct LNnT entry. The implementation of saturation mutagenesis at positions 223 and 228 of LgtA yielded advantageous mutant variants that did not affect LNnT synthesis while significantly reducing the production of longer oligosaccharide derivatives. The most effective mutant, N223I, reduced the molar ratio of long derivatives by nearly 70%, showcasing promising prospects for LNnT production with diminished byproducts.

Quantifying Stated Preferences for Meningococcal Vaccines Among Adolescents/Young Adults and Parents of Adolescents in the United States: A Discrete Choice Experiment.

Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3×4) and levels (1×2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Totals of 300 adolescents and young adults (median age 20years) and 300 parents (median age 46years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.

Genetic characterization and estimated 4CMenB vaccine strain coverage of 284 Neisseria meningitidis isolates causing invasive meningococcal disease in Argentina in 2010–2014

ABSTRACT Meningococcal (Neisseria meningitidis) serogroup B (MenB) strain antigens are diverse and a limited number of strains can be evaluated using the human serum bactericidal antibody (hSBA) assay. The genetic Meningococcal Antigen Typing System (gMATS) was developed to predict the likelihood of coverage for large numbers of isolates by the 4CMenB vaccine, which includes antigens Neisseria adhesin A (NadA), Neisserial Heparin-Binding Antigen (NHBA), factor H-binding protein (fHbp), and Porin A (PorA). In this study, we characterized by whole-genome analyses 284 invasive MenB isolates collected from 2010 to 2014 by the Argentinian National Laboratories Network (52–61 isolates per year). Strain coverage was estimated by gMATS on all isolates and by hSBA assay on 74 randomly selected isolates, representative of the whole panel. The four most common clonal complexes (CCs), accounting for 81.3% of isolates, were CC-865 (75 isolates, 26.4%), CC-32 (59, 20.8%), CC-35 (59, 20.8%), and CC-41/44 (38, 13.4%). Vaccine antigen genotyping showed diversity. The most prevalent variants/peptides were fHbp variant 2, NHBA peptides 24, 21, and 2, and PorA variable region 2 profiles 16–36 and 14. The nadA gene was present in 66 (23.2%) isolates. Estimated strain coverage by hSBA assay showed 78.4% of isolates were killed by pooled adolescent sera, and 51.4% and 64.9% (based on two different thresholds) were killed by pooled infant sera. Estimated coverage by gMATS (61.3%; prediction interval: 55.5%, 66.7%) was consistent with the infant hSBA assay results. Continued genomic surveillance is needed to evaluate the persistence of major MenB CCs in Argentina.

Evaluation of the Bio-Speedy Meningitis/Encephalitis Panel in the Diagnosis of Central Nervous System Infections

Infections of the central nervous system (CNS) can lead to severe outcomes if not accurately diagnosed and treated. The broad spectrum of pathogens involved in CNS infections can make diagnosis challenging. Polymerase chain reaction (PCR) -based multiplex molecular diagnostic panels can rapidly and simultaneously detect multiple neuropathogens in cerebrospinal fluid (CSF). This study was aimed to assess the Bio-Speedy Meningitis/Encephalitis RT-PCR MX-17 panel (Bioeksen, İstanbul, Türkiye), a novel multiplex PCR test, in diagnosing CNS infections. The panel can detect a range of pathogens, including Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, enterovirus (EV), herpes simplex virus (HSV) 1 and 2, HHV-6, HHV-7, HHV-8, human parechovirus (HPeV), varicella zoster virus (VZV), cytomegalovirus (CMV) and Cryptococcus gatti/neoformans in CSF samples. This retrospective study included 128 CSF samples from 128 patients sent to Bursa Uludağ University Health Application and Research Center Microbiology Laboratory between June 2022 and July 2023 to search for CNS infectious agents. Patient clinical, radiological and laboratory data were collected from the Hospital Information Record System (HIRS). Bacterial pathogens were identified through culture, while viral pathogens were detected in CSF samples using the Fast Track Diagnostics (FTD) multiplex RT-PCR panel (Fast Track Diagnostics Ltd., Luxembourg) for HSV-1, HSV-2, VZV, EV, mumps virus and HPeV. The stored CSF samples were then tested using the BioSpeedy panel and the results were compared with those of the culture and the FTD panel. Pathogens that were detected were considered positive if they were consistent with the patient's symptoms and CSF characteristics according to infectious disease and pediatric infectious disease specialists. Pathogens detected but not supported by the patient's symptoms and CSF characteristics were classified as uncertain clinical relevance (UCR). Out of the 128 patients tested for CNS infectious agents, 44 (34.4%) were diagnosed with a CNS infection. The overall pathogen detection rate with all methods was 43.2% (19/44). The Bio-Speedy panel identified pathogens in 29.5% (13/44) of the patients, followed by the FTD panel (20.5%, 9/44) and culture (9.1%, 4/44). Four bacteria were identified with culture, three of which were also detected by the Bio-Speedy panel. Additionally, six bacteria were identified with Bio-Speedy panel, that were not identified by culture. The FTD panel identified nine viruses, four of which were also identified by Bio-Speedy. In total, the Bio-Speedy panel detected 13 of the 19 positive pathogens (nine bacteria and four viruses: [S.pneumoniae (n= 3), VZV (n= 3), N.meningitidis (n= 2), H.influenzae (n= 2), L.monocytogenes (n= 1), E.coli (n= 1) ve EV (n= 1)]. However, the Bio-Speedy panel identified 15 pathogens [S.pneumoniae (n= 1), E.coli (n= 1), C.gatti/neoformans (n= 1), CMV (n= 8), HHV-6 (n= 3) ve HHV-7 (n= 1)] considered as UCR. The Bio-Speedy identified the causative pathogens in the highest percentage (29.5%) of patients with confirmed CNS infections. Nevertheless, test results should be interpreted based on patient characteristics to ensure appropriate patient management. Using multiple methods and multiplex tests may improve diagnostic accuracy for CNS infections.

Meningitis and encephalitis in Poland in 2022.

Monitoring of meningitis and/or encephalitis regardless of etiology is part of routine epidemiological surveillance in Poland. In this study, we discuss in detail meningitis and/or encephalitis in 2022 caused by Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and tick-borne encephalitis virus. The aim of this study was an epidemiological assessment of the occurrence of meningoencephalitis and encephalitis in Poland in 2022, taking into account the analysis of the impact of the COVID-19 pandemic. To analyze the epidemiological situation of neuroinfections in Poland, we used data sent to NIPH NIH-NRI by the Sanitary and Epidemiological Stations and published in the annual bulletins: "Infectious Diseases and Poisons in Poland in 2022" and "Vaccinations in Poland in 2022" as well as individual epidemiological interviews registered in the EpiBase system. In 2022, a total of 1747 cases of meningitis and/or encephalitis were registered in Poland. This was a 79.4% increase in the number of cases compared to 2021, when 974 cases were recorded. For infections of bacterial etiology, including cases of neuroborreliosis, the number of cases increased by 62.3% . The incidence of meningitis and/or encephalitis of N. meningitidis etiology meningitidis increased by 30.8%, with etiology of H. influenzae compared to 2021 increased by 300%, and for S. pneumoniae by 71.9%. Infections of viral etiology accounted for 52% of all registered cases. There was an increase in their number by 99.1% compared to 2021. Among viral infections, tick-borne encephalitis was the most numerous group, with 466 cases compared to 210 in 2021. The year 2022 showed an overall upward trend in the number of registered cases of bacterial and viral meningitis and/or encephalitis compared to 2021. Still, the observed number of cases of meningitis and/or encephalitis of both bacterial and viral origin remains below the levels observed in the period before the COVID-19 pandemic.

Long-term efficacy and safety of continued complement C1s inhibition with sutimlimab in cold agglutinin disease: CADENZA study Part B

Cold agglutinin disease (CAD) is a rare autoimmune haemolytic anaemia mediated by the classical complement pathway (CP). Sutimlimab selectively targets complement C1s inhibiting classical CP activation. In CADENZA Part A (26-weeks), a placebo-controlled study in patients without recent transfusion history, sutimlimab reduced haemolysis, anaemia, and fatigue, and was generally well tolerated. The CADENZA study (NCT03347422) started in March 2018 (Part A) and completed in December 2021 (Part B). All patients in Part B were eligible to receive sutimlimab for up to 1 year after the last patient completed Part A. Efficacy and safety was assessed throughout Part B, until the last on-treatment visit with available assessment (LV), and after a 9-week washout. In total, 32/39 patients completed Part B; median treatment duration: 99 weeks. Similar sustained improvements in haemolysis, anaemia, and quality of life were observed in patients switching to sutimlimab and those continuing sutimlimab. Mean LV values for the combined group (ie, placebo-to-sutimlimab group and sutimlimab-to-sutimlimab group) improved from baseline for haemoglobin (≥11.0g/dL on-treatment vs 9.3g/dL at baseline), bilirubin (≤20.0μmol/L on-treatment vs 35.0μmol/L at baseline), and FACIT-Fatigue scores. Following a 9-week washout, inhibition of CP activity was reversed, and haemolytic markers approached baseline levels. Overall, sutimlimab was generally well tolerated throughout the study. No patients developed systemic lupus erythematosus or meningococcal infections. During the 9-week washout, most adverse events could be attributed to recurrence of underlying CAD. The CADENZA Part B results support the sustained efficacy and safety of sutimlimab for treatment of CAD; however, upon discontinuation disease activity reoccurs. Sanofi.

Analysis and Evaluation of Treatment and Rehabilitation Measures for Children with Cerebral Palsy

The study is devoted to the analysis of disability in children with cerebral palsy in the Kyrgyz Republic. Social impairment is typical for children with cerebral palsy, caused in most cases by multiple types of disability - restrictions on physical independence and mobility; ability to obtain an education, and master the basics of professional activity in the future, readiness for integration into society. In addition, there are problems about the impact of medical, demographic, socio-economic factors, as well as health care resources on morbidity statistics and the incidence of cerebral palsy. The article analyzes the activities of the rehabilitation center for children with musculoskeletal disabilities in the city of Osh for 2021-2023. In order to assess the quality of medical rehabilitation, an analysis and assessment of the medical history of the Center for Medical Rehabilitation from 2021-2023 was also carried out. The interviewing was carried out using a questionnaire specially developed by us, including 12 questions. When analyzing the medical history of children diagnosed with cerebral palsy who underwent medical rehabilitation at the center, it was revealed that the main causes of this condition are: birth injuries, intrauterine infection, premature birth, low birth weight, neuroinfection and severe meningococcal infection before the age of years, anemia, congenital malformations and various somatic diseases. The data obtained confirm the need to create a unified database of children with cerebral palsy (CP). This will improve the organization of medical and social rehabilitation of children suffering from cerebral palsy. The joint database will help collect information on the reasons, characteristics and effectiveness of various rehabilitation methods, which in turn will contribute to more effective management and care of this vulnerable group of children.

Vaccination in children living with HIV – review of Polish recommendations

Vaccines are an extremely effective primary prevention tool recommended for routine use in children worldwide. Vaccination is crucial for patients with underlying diseases, including children living with HIV, because of their increased risk of morbidity and mortality from various vaccine-preventable diseases. Complex care for patients living with HIV includes antiretroviral therapy (which has dramatically improved survival), prophylaxis and treatment of common infections, prophylaxis and treatment of opportunistic infections, and vaccination. Immunisation is generally safe and beneficial for children living with HIV, although HIV-induced immune suppression reduces the benefits. All inactivated vaccines, whether killed whole organism or subunit, recombinant, toxoid, polysaccharide or conjugate (which includes diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, hepatitis B, hepatitis A, Streptococcus pneumoniae vaccines, Neisseria meningitidis, influenza, HPV), can be administered safely. Live attenuated measles–mumps–rubella and varicella vaccines are indicated in children without severe immunodeficiency. The Bacillus Calmette–Guérin vaccine is contraindicated due to the risk of disseminated BCG infection. Although a live attenuated influenza vaccine is available, it is contraindicated for people living with HIV because of the paucity of safety data and the availability of alternative vaccines. The study reviews the current paediatric immunisation recommendations in HIV infection in Poland. Additionally, we focus on vaccine effectiveness, especially HBV protection based on anti-Hbs antibodies.

Serogroup B Protein Meningococcal Vaccines and the Formation of Immune Protection against Gonorrhea

Relevance. Gonorrhea is a widespread infection. More than 80 million cases of this disease occur annually. The problem is compounded by the growing resistance of gonococcus to antibiotics worldwide. The only way out in this situation may be the immunization of certain groups of the population against this infection. Despite the numerous efforts of specialists, there is currently no registered vaccine against gonorrhea, which is due to the characteristics of the pathogen. However, over the past 30 years, reliable observations have accumulated that vaccines containing N. meningititidis serogroup B outer membrane proteins (OMP), developed for prophylaxis meningococcal infection, can also prevent a significant proportion of gonorrhea cases. Aims. To give a brief overview of publications on the reduction of the incidence of gonorrhea in individuals who received vaccines containing N. meningitidis serogroup B outer membrane vesicles, followed by an analysis of information about the nature of these proteins and methods of their study, as a promising platform for creating a vaccine against gonococcus. Conclusions. There is a theoretical and real possibility of creating a preventive drug against gonorrhea. Our analysis of literature sources showed that during the period 2006–2016 from 31% to 59% of those vaccinated with the protein meningococcal vaccine В were protected from gonorrhea. It is necessary to continue studying meningococcal OMV in terms of their preventive properties against gonorrhea, improve the set of models to identify their protective effect, and find adjuvants that enhance the immunogenicity of potential vaccine candidates.

Occurrence and Distribution of Potential Dangerous Biological Agents in Beijing Suburban Rivers

Dangerous biological agents （DBAs） refer to microorganisms, toxins, and other biological substances that have the potential to cause significant harm to humans, animals, plants, and the environment. They are the primary target of the prevention and response in China's Biosafety Law, and it is of great importance to clarify the characteristics of DBAs in the Beijing suburban rivers for the insurance of the water safety in Beijing. The typical Beijing suburban rivers （Mangniu River, Chaohe River, and Baihe River） were selected, and the occurrence and distribution of DBAs concerning the molecular biology composition as the nucleic acid （antibiotic resistance genes, ARGs）, nucleic acid and proteins （viruses）, and intact cellular structures （pathogens） were determined based on the metagenomics. The results showed that there was a high abundance of multidrug-resistant ARGs in the water and substrates of the urban river； on average, they made up 74.11% ±6.82% of the total, and the abundance of aminoglycoside and MLS （macrolide-lincosamide-streptomycin）-resistant ARGs was the highest, but the predominant subtypes of ARGs were of low risk and had limited transmission potential. The viruses in the tributary mainly belonged to the phages, most of which were Kyanoviridae and Peduoviridae, with averages of 16.98% ±8.44% and 16.19% ±10.79%, respectively. Eukaryotic viral populations consisted mainly of members from the Mimiviridae and Phycodnaviridae families, with averages of 10.37% ±12.68% and 8.34% ±6.97%, respectively, whereas there were few viruses related to human and animal diseases. The pathogenic bacteria mainly contained Neisseria meningitidis, Brucella suis, Salmonella enterica, and Burkholderia pseudomalle, with averages of 19.17% ±3.63%, 12.76% ±2.88%, 11.22% ±1.95%, and 8.26% ±1.84%, respectively. The composition and abundance of pathogenic bacteria varied significantly among different tributaries and locations, possibly owing to water quality, pollution sources, environmental factors, and human activities. These findings can provide data support for the water safety management and biological risk control of Beijing suburban rivers.

Threat of Invasive Meningococcal Disease Linked to Travel in State of Kuwait

Threat of Invasive Meningococcal Disease Linked to Travel in State of Kuwait

Automating the Generation of Notifiable Bacterial Disease Reports: Proof-of-Concept Study and Implementation in Six Hospitals in Thailand.

Information on notifiable bacterial diseases (NBD) in low- and middle-income countries (LMICs) is frequently incomplete. We developed the AutoMated tool for the Antimicrobial resistance Surveillance System plus (AMASSplus), which can support hospitals to analyze their microbiology and hospital data files automatically (in CSV or Excel format) and promptly generate antimicrobial resistance surveillance and NBD reports (in PDF and CSV formats). The NBD reports included the total number of cases and deaths after Brucella spp., Burkholderia pseudomallei, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Neisseria meningitidis, nontyphoidal Salmonella spp., Salmonella enterica serovar Paratyphi, Salmonella enterica serovar Typhi, Shigella spp., Streptococcus suis, and Vibrio spp. infections. We tested the tool in six hospitals in Thailand in 2022. The total number of deaths identified by the AMASSplus was higher than those reported to the national notifiable disease surveillance system (NNDSS); particularly for B. pseudomallei infection (134 versus 2 deaths). This tool could support the NNDSS in LMICs.

The impact of regional disparities on the availability of meningococcal vaccines in the US

BackgroundIn the United States (US), three types of vaccines are available to prevent invasive meningococcal disease (IMD), a severe and potentially fatal infection: quadrivalent conjugate vaccines against serogroups A, C, W, Y (MenACWY), and monovalent vaccines against serogroup B (MenB) as well as a newly licensed pentavalent vaccine (MenABCWY) protecting against serogroup A, B, C, W, and Y. The CDC’s Advisory Committee on Immunization Practices (ACIP) routinely recommends MenACWY vaccine for all 11- to 12-year-olds with a booster dose at 16 years. MenB vaccination is recommended based on shared clinical decision-making (SCDM) for 16- to 23-year-olds. Recently, the pentavalent meningococcal vaccine (MenABCWY) was recommended by the ACIP. Meningococcal vaccine uptake is suboptimal across the country, particularly among individuals with lower socioeconomic status (SES), despite these recommendations. The objective of the spatial analyses was to assess the relationship between stocking of MenACWY and MenB vaccines, area-level SES, and state-level policies.MethodsThe number of MenACWY and MenB doses stocked by vaccinators was obtained from IQVIA and the CDC’s Vaccine for Children (VFC) program and compiled into a county-level dataset from 2016 to 2019. SES, as measured using the CDC’s Social Vulnerability Index (SVI), state-level school recommendations, and universal purchasing programs were among the main county-level covariates included to control for factors likely influencing stocking. Data were stratified by public and private market. Bayesian spatial regression models were developed to quantify the variations in rates of stocking and the relative rates of stocking of both vaccines.ResultsAfter accounting for county-level characteristics, lower SES counties tended to have fewer doses of MenB relative to MenACWY on both public and private markets. Lower SES counties tended to have more supply of public vs. private doses. Universal purchasing programs had a strong effect on the markets for both vaccines shifting nearly all doses to the public market. School vaccination strategy was key for improving stocking rates.ConclusionsOverall, the results show that MenACWY has greater stock relative to MenB across the US. This difference is exacerbated in vulnerable areas without school entry requirements for vaccination and results in inequity of vaccine availability. Beyond state-level policy and SES differences, SCDM recommendations may be a contributing factor, although this was not directly assessed by our model.

Epidemiological and bacterial profile ofchildhood meningitis in Tunisia.

The worldwide burden of disease of bacterial meningitis remains high, despite the decreasing incidence following introduction of routine vaccination campaigns.The aim of our study was to evaluate the epidemiological and bacteriological profile of paediatric bacterial meningitis (BM) in Tunisian children, during the period 2003-2019, following the implementation of Haemophilus influenzae type b (Hib) vaccine (April 2011) and before 10-valent pneumoccocal conjugate vaccine (PCV10) introduction to the childhood immunization program.All bacteriologically confirmed cases of BM admitted to children's hospital of Tunis were recorded (January 2003 to April 2019). Serogroups of Neisseria meningitidis (Nm) and serotypes of Streptococcus pneumoniae (Sp) and H. influenzae (Hi) and antibiotic resistance were determined using conventional and molecular methods.Among 388 cases, the most frequent species were Sp (51.3%), followed by Nm (27.5%) and Hi(16.8%). We observed a significant decrease in Hi BM rate during the conjugated Hib vaccine use period (P < 0.0001). The main pneumococcal serotypes were 14, 19F, 6B, 23F and 19A and the serotype coverage of PCV10, PCV13, PCV15 and PCV20 was 71.3 and 78.8%, 79.4 and 81.9% respectively. Themost frequent Nm serogroup was B (83.1%). Most Hi strains were of serotype b (86.9%). High levels of resistance were found: Sp and Nm to penicillin (respectively 60.1 and 80%) and Hi to ampicillin (42.6%). All meningococcal and Hi isolates were susceptible to third-generation cephalosporins and 7.2% of pneumococcal strains had decreased susceptibility to these antibiotics.The Hib conjugate vaccine decreased the rate of BM. Sp dominated the aetiology of BM in children in Tunisia. Conjugate vaccines introducing decreases not only BM cases but also antimicrobial resistance.

An Investigation of Ciprofloxacin-resistant Neisseria Meningitidis Serogroup B Infection Outbreak in a Provincial Prison, Nan Province, Thailand, October 2023

Meningococcal infection is a severe illness that can result in organ damage or death. On 23 Oct 2023, a joint investigation team was notified about two inmates diagnosed with meningococcal infection in a provincial prison. The investigation aimed to confirm the outbreak, describe epidemiological characteristics, determine possible source and risks of infection, and provide recommendations and control measures. This study reviewed the situation using surveillance databases. Active case finding was conducted among inmates and prison staff. Close contacts were identified and assessed. Drug sensitivity and serogroup identification were done in the cultured-growth specimens. Surveying inmate rooms, observing inmates' behaviors, and interviewing inmates and prison staff were performed. There were 7 laboratory-confirmed cases identified (attack rate 0.5%). All cases were male inmates with a median age of 46 years (interquartile range 38.5–49.5 years). Common symptoms were fever (100%) and headache (71%). Eight cases required hospital admission and one dead case was found (CFR 14%). Among 609 close contacts, 99% were inmates. All cultured-growth specimens were Neisseria meningitidis serogroup B with ciprofloxacin resistance. Crowded inmates and sharing water cups were risk factors for intra-room spreading. Daily activities and the previous influenza outbreak promoted inmates' inter-room contact. This is the ciprofloxacin-resistant serogroup B meningococcal disease outbreak in a provincial prison revealing multiple factors, including environmental, behaviors and daily activities, that promoted the disease's spread. Rifampicin chemoprophylaxis, active surveillance, and limited inmate activities could help reduce disease spread.