Outbreak Of Meningococcal Meningitis Research Articles

Deep coal mining and meningococcal meningitis in England and Wales, 1931–38: Ecological study, with implications for deep shaft mining activities worldwide

The hypothesized role of deep coal mining in the development of community-based outbreaks of meningococcal meningitis has gone largely unexplored. Taking the coalfields of Britain as a historical testbed, techniques of linear and binomial logistic regression were used to assess the association between meningococcal meningitis rates and male occupation rates for coal mining in England and Wales during the national epidemic of 1931–32 and in its aftermath. Adjusting for the epidemiological effects of age, residential density, recent changes in the number of families, housing stock and low social class, the analysis yielded evidence of a significant and positive association between coal mining occupation rates and notified levels of meningitis activity in the epidemic period. Communities in areas of the world that currently maintain substantial deep coal extraction industries may be at increased risk for the epidemic transmission of meningococcal meningitis.

Emergence and genomic diversification of a virulent serogroup W:ST-2881(CC175) Neisseria meningitidis clone in the African meningitis belt.

Countries of the African ‘meningitis belt’ are susceptible to meningococcal meningitis outbreaks. While in the past major epidemics have been primarily caused by serogroup A meningococci, W strains are currently responsible for most of the cases. After an epidemic in Mecca in 2000, W:ST-11 strains have caused many outbreaks worldwide. An unrelated W:ST-2881 clone was described for the first time in 2002, with the first meningitis cases caused by these bacteria reported in 2003. Here we describe results of a comparative whole-genome analysis of 74 W:ST-2881 strains isolated within the framework of two longitudinal colonization and disease studies conducted in Ghana and Burkina Faso. Genomic data indicate that the W:ST-2881 clone has emerged from Y:ST-175(CC175) bacteria by capsule switching. The circulating W:ST-2881 populations were composed of a variety of closely related but distinct genomic variants with no systematic differences between colonization and disease isolates. Two distinct and geographically clustered phylogenetic clonal variants were identified in Burkina Faso and a third in Ghana. On the basis of the presence or absence of 17 recombination fragments, the Ghanaian variant could be differentiated into five clusters. All 25 Ghanaian disease isolates clustered together with 23 out of 40 Ghanaian isolates associated with carriage within one cluster, indicating that W:ST-2881 clusters differ in virulence. More than half of the genes affected by horizontal gene transfer encoded proteins of the ‘cell envelope’ and the ‘transport/binding protein’ categories, which indicates that exchange of non-capsular antigens plays an important role in immune evasion.

Pattern of the meningococcal meningitis outbreak in Northern Nigeria, 2009.

Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities.

Kinetic characterization of the α‐2,9 polysialyltransferase of Neisseria meningitidis

Neisseria meningitidis Serogroup C is responsible for the majority of the meningococcal meningitis outbreaks in the United States in the past 20 years. The serogroup polysaccharide, an α‐2, 9 polysialic acid, of the pathogen is essential for virulence. This highlights the importance understanding of the enzymes involved in its biosynthesis as it may lead to the development of new drugs targeting this disease.We are interested in obtaining a detailed understanding of the kinetics of the α‐2, 9 polysialyltransferase involved in the formation of the polysaccharide capsule of N. meningitidis. Studies of the α‐2, 8 polysialyltransferase conducted by the Wakarchuk group obtained an apparent Km in the low mM range for CMP‐sialic acid. Using the α‐2, 9 polysialyltransferase we obtained an apparent Kmvalue in the low µM range for CMP‐sialic acid. We believe that this large discrepancy in Km is due primarily to the differences in assay methods and conditions.Using CMP‐sialic acid as the donor substrate, we compared acceptor substrate specificity of GD3, a ganglioside, with a hexamer of sialic acid. We observed a lower apparent Km value for GD3 compared with the hexamer suggesting that the attachment of a lipid to the oligosaccharide improves substrate binding. However, the enzyme does not appear to follow Michaelis‐Menten kinetics. The complexity of the reaction kinetics may be due to fact that each product formed via the transfer of sialic acid from CMP‐sialic acid in turn produces a new substrate. To address this issue we used CMP‐sialic acid analogs modified at the N‐9 position to observe a single turnover of product, which allowed us to perform detailed kinetic characterization of the enzyme.

Emergence of a new epidemic Neisseria meningitidis serogroup A Clone in the African meningitis belt: high-resolution picture of genomic changes that mediate immune evasion.

ABSTRACTIn the African “meningitis belt,” outbreaks of meningococcal meningitis occur in cycles, representing a model for the role of host-pathogen interactions in epidemic processes. The periodicity of the epidemics is not well understood, nor is it currently possible to predict them. In our longitudinal colonization and disease surveys, we have observed waves of clonal replacement with the same serogroup, suggesting that immunity to noncapsular antigens plays a significant role in natural herd immunity. Here, through comparative genomic analysis of 100 meningococcal isolates, we provide a high-resolution view of the evolutionary changes that occurred during clonal replacement of a hypervirulent meningococcal clone (ST-7) by a descendant clone (ST-2859). We show that the majority of genetic changes are due to homologous recombination of laterally acquired DNA, with more than 20% of these events involving acquisition of DNA from other species. Signals of adaptation to evade herd immunity were indicated by genomic hot spots of recombination. Most striking is the high frequency of changes involving the pgl locus, which determines the glycosylation patterns of major protein antigens. High-frequency changes were also observed for genes involved in the regulation of pilus expression and the synthesis of Maf3 adhesins, highlighting the importance of these surface features in host-pathogen interaction and immune evasion.

Remote-Sensing Applications for Environmental Health Research

More than 1,000 manmade satellites currently orbit our planet.1 Some are near the edge of the Earth’s atmosphere just a few hundred kilometers up. Others are tens of thousands of kilometers above us.2 They aid in communication, navigation, defense, and science. A small number3,4 play a critical and quickly expanding role: monitoring the Earth’s surface and atmosphere to track environmental conditions that are intimately tied to human health. A number of new Earth-observing missions are planned for the next decade, including Sentinel-5 aboard the European Space Agency’s MetOp Second Generation satellites (pictured).48 In the meantime researchers are finding new uses for the satellite ... Researchers and government agencies worldwide already use satellite data to monitor air pollutants, infectious disease epidemics, harmful algal blooms (HABs), climate change, and more. But as current research indicates, that’s only the beginning of what we can do with the technology, broadly referred to as “remote sensing.” In the coming years, new satellites will offer higher-resolution imagery in conjunction with more robust and precise algorithms to process the data they deliver. As a result, researchers expect to dramatically expand their ability to view and understand Earth’s land, water, and air, from its remotest ocean waters to its largest cities. The National Aeronautics and Space Administration (NASA) launched its first satellite in 1958,5 and TIROS-1, the country’s first meteorological satellite, came 2 years later.6 Within a few decades members of the epidemiological and public health communities began actively looking at satellite data, says John Haynes, program manager of the NASA Applied Sciences Health and Air Quality Applications Program. In recent years interest in remote-sensing data has soared, with newer avenues being developed and fine-tuned, including air-quality measurements and vector-borne disease projections. “There’s really been a paradigm shift in the use of remote sensing for public health issues,” Haynes says. “Every year there seems to be more and more interest.” Indeed, by March 2015 NASA will have launched 6 Earth-observing missions in 12 months,7 more than in any year in at least a decade.8 New launches include a “global precipitation observatory” that will make frequent global measurements of rain and snowfall, plus one satellite designed to measure soil moisture and another that will measure how carbon moves through the Earth’s atmosphere, land, and oceans. In addition, the International Space Station will receive three new instruments, one that will observe how winds behave around the world, one that will measure clouds and aerosols (particles suspended in the atmosphere)—two variables that remain difficult to predict in climate-change models—and one that will take global, long-term measurements of key components of the Earth’s atmosphere, including aerosols and ozone.9 The momentum will carry through at least the next 8 or so years, with NASA and other space agencies in Europe and Asia planning to launch new satellites that will provide even higher-resolution snapshots of the Earth. Along with technological and scientific advances, a third development is leading to new and improved applications of satellite data: NASA and the National Oceanic and Atmospheric Administration (NOAA) have made their satellite data available free of charge, Haynes says, while the European Space Agency (ESA) has reduced prices and promised to provide free access to data from its next generation of instruments. “More people use the data, and you get more out of it than when you try to restrict it,” says Raphael Kudela, an oceanographer at the University of California, Santa Cruz, who uses satellite imagery to study HABs. This free sharing of data has been instrumental in his field, allowing researchers at institutions around the world to study HABs from above and to improve systems to track and predict them.

Expanding Poliomyelitis and Measles Surveillance Networks to Establish Surveillance for Acute Meningitis and Encephalitis Syndromes—Bangladesh, China, and India, 2006-2008

Quality surveillance is critical to the control and elimination of vaccine-preventable diseases (VPDs). A key strategy for enhancing VPD surveillance, outlined in the World Health Organization (WHO) Global Framework for Immunization Monitoring and Surveillance (GFIMS), is to expand and link existing VPD surveillance systems (particularly those developed for polio eradication and measles elimination) to include other priority VPDs. Since the launch of the Global Polio Eradication Initiative in 1988, the incidence of polio has decrease by 99% worldwide. A cornerstone of this success is a sensitive surveillance system based on the rapid and timely reporting of all acute flaccid paralysis (AFP) cases in children aged <15 years, with confirmatory diagnostic testing performed by laboratories that are part of a global network. As countries achieve polio-free status, many have expanded syndromic surveillance to include persons with rash and fever, and have built measles diagnostic capacity in existing polio reference laboratories. Acute meningitis/encephalitis syndrome (AMES) and acute encephalitis syndrome (AES) are candidates for expanded surveillance because they are most often caused by VPDs of public health importance for which confirmatory laboratory tests exist. Vaccine-preventable cases of encephalitis include approximately 68,000 Japanese encephalitis (JE) cases, resulting in 13,000-20,000 deaths each year in Asia. Moreover, although bacterial meningitis incidence in Asia is not as well-documented, pneumococcal and meningococcal meningitis outbreaks have been reported in Bangladesh and China, and the incidence of Haemophilus influenzae type b (Hib) meningitis in children aged <5 years in India has been estimated to be 7.1 per 100,000 population, similar to that in European countries before the introduction of vaccine. This report describes a prototype for expanding existing polio and measles surveillance networks in Bangladesh, China, and India to include surveillance for viral and bacterial vaccine-preventable causes of AMES and AES and presents data from 2006-2008.

Analysing spatio-temporal clustering of meningococcal meningitis outbreaks in Niger reveals opportunities for improved disease control.

BackgroundMeningococcal meningitis is a major health problem in the “African Meningitis Belt” where recurrent epidemics occur during the hot, dry season. In Niger, a central country belonging to the Meningitis Belt, reported meningitis cases varied between 1,000 and 13,000 from 2003 to 2009, with a case-fatality rate of 5–15%.Methodology/Principal FindingsIn order to gain insight in the epidemiology of meningococcal meningitis in Niger and to improve control strategies, the emergence of the epidemics and their diffusion patterns at a fine spatial scale have been investigated. A statistical analysis of the spatio-temporal distribution of confirmed meningococcal meningitis cases was performed between 2002 and 2009, based on health centre catchment areas (HCCAs) as spatial units. Anselin's local Moran's I test for spatial autocorrelation and Kulldorff's spatial scan statistic were used to identify spatial and spatio-temporal clusters of cases. Spatial clusters were detected every year and most frequently occurred within nine southern districts. Clusters most often encompassed few HCCAs within a district, without expanding to the entire district. Besides, strong intra-district heterogeneity and inter-annual variability in the spatio-temporal epidemic patterns were observed. To further investigate the benefit of using a finer spatial scale for surveillance and disease control, we compared timeliness of epidemic detection at the HCCA level versus district level and showed that a decision based on threshold estimated at the HCCA level may lead to earlier detection of outbreaks.Conclusions/SignificanceOur findings provide an evidence-based approach to improve control of meningitis in sub-Saharan Africa. First, they can assist public health authorities in Niger to better adjust allocation of resources (antibiotics, rapid diagnostic tests and medical staff). Then, this spatio-temporal analysis showed that surveillance at a finer spatial scale (HCCA) would be more efficient for public health response: outbreaks would be detected earlier and reactive vaccination would be better targeted.

Epidemic Meningococcal Meningitis, Cameroon

To the Editor: In 2010, the city of Ngaoundere in Cameroon experienced its first reported epidemic of meningococcal meningitis. Ngaoundere, with an estimated population of 180,000, is the main city in the Adamaoua region in northern Cameroon. The 2 northernmost regions of Cameroon, North and Far North, are considered to belong to the African meningitis belt (1) and are periodically affected by meningococcal meningitis outbreaks. However, the Adamaoua region had been spared because of its altitude, latitude, and low population density in comparison with the North and Far North regions. Fewer than 10 sporadic cases have been reported in the Adamaoua region every year. During February–April 2010, a total of 126 cases of meningitis (70 cases/100,000 inhabitants) were reported in the Adamaoua region. Of the 126 cases, 34 were confirmed by identification of Neisseria meningitidis serogroup A in cerebrospinal fluid (CSF) samples, 46 cases were apparent meningitis in which the patients had turbid CSF, and 46 were clinical cases diagnosed in an epidemic context. The male:female ratio of the patients was 2.7:1. The mean age of patients was 19 years, and median was 17 years. CSF specimens from 34 patients were sent to the Centre Pasteur du Cameroun in Garoua for testing. Laboratory procedures included assessing CSF turbidity, Gram staining, searching for soluble capsular antigens by using the Pastorex latex agglutination kit (Bio-Rad, Hercules, CA, USA), and testing by the dipstick rapid diagnostic test for N. meningitidis serogroups A, C, W135, and Y (provided by the Centre de Recherche Medicale et Sanitaire, Niamey, Niger). All 34 specimens were positive for serogroup A by agglutination, rapid test, or both. CSF specimens were cultured on blood agar and chocolate agar supplemented with PolyViteX (bioMerieux, Marcy-l’Etoile, France) and incubated at 37°C in an atmosphere of 5% CO2. Susceptibility to antimicrobial drugs was tested according to the recommendations of the Antibiogram Committee of the French Society for Microbiology (www.sfm.asso.fr). An isolate of N. meningitidis was sent to the World Health Organization Collaborating Centre for Reference and Research on Meningococci in Oslo, Norway, for molecular analyses, as described (www.neisseria.org). The result was that the isolate, a N. meningitidis serogroup A clone of sequence type 7, was susceptible to β-lactams and chloramphenicol but resistant to trimethoprim/sulfamethoxazole. This epidemic occurred in an area where the mean annual rainfall for the past 30 years was 1,460 mm (Agency for Aerial Navigation Safety in Africa and Madagascar, unpub. data). This value should exclude Ngaoundere from the African meningitis belt, for which the southern limit of annual rainfall was classically considered to be the 1,100-mm isohyet (Figure). Figure Northern regions of Cameroon with mean annual rainfall. Maroua is at the 800 mm isohyet line, Garoua at 1,006 mm, and Ngaoundere at 1,460 mm. Estimate for Maroua is by the Agency for Aerial Navigation Safety in Africa and Madagascar; recorded ... This epidemic at the border of the African meningitis belt raises the question of the belt limitation and its potential expansion southward. These topics should be addressed through active and standardized surveillance in countries such as Cameroon, which are not entirely included in the belt (2,3). This meningitis epidemic has 2 other noteworthy characteristics. First, 80 (63%) of 126 suspected cases had a lumbar puncture performed at the Ngaoundere Regional Hospital or at the Norwegian hospital. With the help of the laboratory, an increasing number of cases of meningitis in Cameroon are confirmed cases (4). Second, the etiologic agent was serogroup A meningococcus, a serogroup that had not been identified in north Cameroon since 2006 (5) but that had been isolated previously (6) and in south Cameroon (7).

Spatial dynamics of meningococcal meningitis in Niger: observed patterns in comparison with measles.

Throughout the African meningitis belt, meningococcal meningitis outbreaks occur only during the dry season. Measles in Niger exhibits similar seasonality, where increased population density during the dry season probably escalates measles transmission. Because meningococcal meningitis and measles are both directly transmitted, we propose that host aggregation also impacts the transmission of meningococcal meningitis. Although climate affects broad meningococcal meningitis seasonality, we focus on the less examined role of human density at a finer spatial scale. By analysing spatial patterns of suspected cases of meningococcal meningitis, we show fewer absences of suspected cases in districts along primary roads, similar to measles fadeouts in the same Nigerien metapopulation. We further show that, following periods during no suspected cases, districts with high reappearance rates of meningococcal meningitis also have high measles reintroduction rates. Despite many biological and epidemiological differences, similar seasonal and spatial patterns emerge from the dynamics of both diseases. This analysis enhances our understanding of spatial patterns and disease transmission and suggests hotspots for infection and potential target areas for meningococcal meningitis surveillance and intervention.

Trends of major disease outbreaks in the African region, 2003–2007

Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the "meningitis belt" (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR) suggesting improvement in detection and quality of response by the health sector, the number of countries affected has increased. Major epidemic diseases continue to occur in most countries in the region. Among the major challenges to overcome are: poor coordination of EPR, weak public health infrastructure, lack of trained workers and inconsistent supply of diagnostic, treatment and prevention commodities. To successfully reduce the levels of morbidity and mortality resulting from epidemic outbreaks, urgent and long-term investments are needed to strengthen capacities for early detection and timely and effective response. Effective advocacy, collaboration and resource mobilization efforts involving local health officials, governments and the international community are critically needed to reduce the heavy burden of disease outbreaks on African populations.

Meningitis Dipstick Rapid Test: Evaluating Diagnostic Performance during an Urban Neisseria meningitidis Serogroup A Outbreak, Burkina Faso, 2007

Meningococcal meningitis outbreaks occur every year during the dry season in the “meningitis belt” of sub-Saharan Africa. Identification of the causative strain is crucial before launching mass vaccination campaigns, to assure use of the correct vaccine. Rapid agglutination (latex) tests are most commonly available in district-level laboratories at the beginning of the epidemic season; limitations include a short shelf-life and the need for refrigeration and good technical skills. Recently, a new dipstick rapid diagnostic test (RDT) was developed to identify and differentiate disease caused by meningococcal serogroups A, W135, C and Y. We evaluated the diagnostic performance of this dipstick RDT during an urban outbreak of meningitis caused by N. meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an in-country reference standard of culture and/or multiplex PCR; and second against culture and/or a highly sensitive nested PCR technique performed in Oslo, Norway. We included 267 patients with suspected acute bacterial meningitis. Using the in-country reference standard, 50 samples (19%) were positive. Dipstick RDT sensitivity (N = 265) was 70% (95%CI 55–82) and specificity 97% (95%CI 93–99). Using culture and/or nested PCR, 126/259 (49%) samples were positive; dipstick RDT sensitivity (N = 257) was 32% (95%CI 24–41), and specificity was 99% (95%CI 95–100). We found dipstick RDT sensitivity lower than values reported from (i) assessments under ideal laboratory conditions (>90%), and (ii) a prior field evaluation in Niger [89% (95%CI 80–95)]. Specificity, however, was similar to (i), and higher than (ii) [62% (95%CI 48–75)]. At this stage in development, therefore, other tests (e.g., latex) might be preferred for use in peripheral health centres. We highlight the value of field evaluations for new diagnostic tests, and note relatively low sensitivity of a reference standard using multiplex vs. nested PCR. Although the former is the current standard for bacterial meningitis surveillance in the meningitis belt, nested PCR performed in a certified laboratory should be used as an absolute reference when evaluating new diagnostic tests.

Response to the meningococcal meningitis epidemic (MME)at Aminu Kano Teaching Hospital, Kano (2008-2009)

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.

Susecptibility Pattern Of Meningococcal Meningitis Outbreak In Nguru, Yobe State, North-Eastern Nigeria

Susecptibility Pattern Of Meningococcal Meningitis Outbreak In Nguru, Yobe State, North-Eastern Nigeria

Neisseria meningitidis with reduced susceptibility to quinolones in Singapore

Sir, Ciprofloxacin is commonly prescribed as a single-dose chemoprophylactic agent for close contacts of patients with meningococcal infection. Neisseria meningitidis with reduced susceptibility to fluoroquinolones has recently emerged, with sporadic cases reported in France, Australia, Argentina, Spain, Hong Kong and Israel. Recently an outbreak of serogroup A emerged in India, and a cluster of three cases of serogroup B in the USA. To our knowledge, failure of ciprofloxacin prophylaxis due to quinolone resistance has not been reported To date, reduced susceptibility to fluoroquinolones in meningococci has remained rare, with 10 unrelated strains found in an analysis of 5300 isolates in Spain, and only 3 from .5000 isolates in France. Most mutations have arisen in GyrA. However, mutations have also been detected in GyrB and ParE, although their significance remains uncertain. In addition, in vitro changes have been induced in ParC and resistance to quinolones has also been reported through an efflux mechanism. – 4 Following the isolation of N. meningitidis with reduced susceptibility to ciprofloxacin from a 36-year-old man with meningitis in 2008, all stored viable clinical isolates from Singapore’s three largest hospitals (Tan Tock Seng, Singapore General and National University hospitals) were screened for reduced susceptibility to nalidixic acid and rifampicin by disc diffusion, using the CLSI guidelines. Ciprofloxacin MICs were determined by agar plate dilution for isolates with reduced susceptibility to nalidixic acid, using the Australian Gonococcal Surveillance Programme (AGSP) guidelines. MICs obtained with this method give identical results for identical GyrA changes in Neisseria gonorrhoeae and N. meningitidis. All isolates for which the MIC is .0.03 mg/L either have changes in the quinolone resistance determining region (QRDR) or an increased efflux of quinolones, while those for which the MIC is ,0.03 mg/L do not. In the absence of clinical correlation data, an MIC of .0.03 mg/L is taken to indicate reduced susceptibility by both the AGSP and CLSI methods. Multilocus sequence typing (MLST) was carried out using protocols available on the Neisseria MLST website. To characterize the mechanisms of resistance to ciprofloxacin, we sequenced the QRDRs of GyrA, GyrB, ParC and ParE of isolates with a ciprofloxacin MIC of .0.03 mg/L. Penicillin MICs were determined with Etests (AB BIODISK, Solna, Sweden) for all isolates, using Mueller–Hinton agar with 5% sheep blood and interpreted according to CLSI criteria for agar dilution. Of 75 isolates collected between 2000 and 2008, two (3%) were resistant to nalidixic acid, a Group C isolate from 2008 and a Group B isolate from 2002. Both isolates had a raised ciprofloxacin MIC of 0.25 mg/L. All 75 isolates were susceptible to rifampicin. There were 13 isolates (17%) intermediate and 2 (3%) resistant to penicillin (MICs of 0.38 and 0.47 mg/L). MLST confirmed that the two isolates with reduced quinolone susceptibility were unrelated. The 2008 isolate was identified as sequence type (ST)-4821. The 2002 isolate was a new ST with alleles 4, 10, 76, 71, 13, 2, 75 although the aroE allele had one nucleotide different from allele 76 (C to T at position 39). The 2008 ST-4821 isolate had the most common GyrA substitution of threonine to isoleucine at position 91. The 2002 isolate had three mutations detected in GyrA: Thr91!Val; Asn103!Asp; and Ala105!Ser. To our knowledge, the Thr91!Val substitution has not been previously described in N. meningitidis. Neither of the isolates had changes in GyrB, ParC or ParE. Similarities in the mechanism of quinolone resistance in meningococci and gonococci, have prompted concerns that resistance will climb to mirror that of gonococci. Resistance to quinolones among N. gonorrhoeae is now so common that use of ciprofloxacin for the treatment of gonorrhoea is no longer recommended by the US Centers for Disease Control and Prevention. In Singapore, ciprofloxacin resistance among gonococci reached an alarming 61.8% in 2006 (74% in 2008; A. L. Tan, unpublished data). Ciprofloxacin is a prescription-only medicine in Singapore, but is in widespread use. An outbreak of meningococcal meningitis with reduced susceptibility to quinolones has already been seen in India in 2005, a country with liberal use of ciprofloxacin. Although our data are from small numbers, as meningococcal infections are uncommon in Singapore (usually ,10 cases per year), the 3% rate of quinolone resistance in this study is remarkably high when compared with other reports. Surveillance for reduced susceptibility and judicious quinolone use is forever increasing in importance but our local resistance data for the related N. gonorrhoeae may suggest the future is already written.

Imported Ciprofloxacin-ResistantNeisseria meningitidis

Imported Ciprofloxacin-Resistant<i>Neisseria meningitidis</i>

Control of meningococcal meningitis outbreaks in sub-Saharan Africa

Outbreaks of Neisseria meningitidis recur frequently in the African Sahel where they are responsible for high mortality and morbidity, especially in children. An effective vaccine has been in existence for more than 30 years, but despite this, the control of epidemics has failed. Moreover, the geographical distribution of N. meningitidis seems to be increasing, perhaps because of climate change but also because of the economic crisis which prevails throughout much of Africa leading to population movements and the breakdown of essential services. Although alarming, the emergence of new serogroups in recent epidemics (such as serogroups X and W135) should not mask the fact that serogroup A remains the most common meningococcal isolate from meningitis cases and is therefore the most significant target for control. The development of a low-cost conjugate meningococcal vaccine should support a strategy of preventive immunization, as this strategy is one that appears most effective to control this plague.

ST2859 serogroup A meningococcal meningitis outbreak in Nouna Health District, Burkina Faso: a prospective study

We analysed cerebrospinal fluid samples from suspected meningitis cases in Nouna Health District, Burkina Faso, during the meningitis seasons of 2004-2006. Serogroup A ST2859 meningococci belonging to the ST5 clonal complex of subgroup III meningococci were the predominant causative agent. ST2859 bacteria were associated with focal outbreaks in the north of the district. While >10% of the population of an outbreak village carried ST2859, the population in the south of the district was predominantly colonised by serogroup Y ST4375 meningococci, which were associated with only sporadic cases of meningitis. Colonisation with the less virulent Y meningococci may interfere with the spread of the ST2859 to the south of the district, but there are concerns that this serogroup A clone may cause a third wave of subgroup III meningococcal disease in the African Meningitis Belt.

Dust Storm Fallout: Tiniest Travelers Pose Greatest Infection Threat

Vol. 116, No. 3 EnvironewsOpen AccessDust Storm Fallout: Tiniest Travelers Pose Greatest Infection Threat Angela Spivey Angela Spivey Search for more papers by this author Published:1 March 2008https://doi.org/10.1289/ehp.116-a128bAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Dust isn’t just a nuisance—its ability to clog human airways and carry pathogens poses a human health problem. In the sub-Saharan region of Africa, the World Health Organization pinpointed dust storms exacerbated by the dry season and drought as a cause of outbreaks of meningococcal meningitis. Dust from Saharan storms can reach as far away as Florida, with particles smaller than 2.5 μm traveling the greatest distances. Studies have shown that human exposure to these tiny particles is associated with human mortality, and new research now shows that such particles are also more likely to carry health-threatening bacteria [EHP 116:292–296; Polymenakou et al.].During a strong Saharan dust storm in 2006, researchers collected air samples in Heraklion, Crete, an area that often feels the effects of such storms. Particles from the samples were separated according to size (> 7.9 μm, 3.3–7.9 μm, 1.6–3.3 μm, 1.0–1.6 μm, 0.55–1.0 μm, or <0.55 μm) using a machine called a high-volume cascade impactor. The researchers characterized the bacteria traveling on particles of various sizes by taking samples from the machine’s filters, then cloning and sequencing a strand of DNA commonly used to identify bacteria. This process created an inventory of the bacterial gene sequences present in each of the six particle-size ranges. The creation of large clone libraries allows investigators to detect bacteria that are missed using culture methods, as some bacteria are difficult to grow.The researchers identified clones that were genetically related to pathogens linked to human diseases such as pneumonia, meningitis, and bacteremia, or to pathogens suspected of inducing infections such as endocarditis. Of the sequenced clones related to bacteria that are dangerous to humans, almost half (43%) were found at particle sizes less than 3.3 μm. Spore-forming bacteria such as Firmicutes dominated the particle sizes larger than 3.3 μm. Most of these bacteria are nonpathogenic.The authors conclude that the prevalence of breathable bacteria on small dust particles may pose a significant, widespread health risk to humans, given that dust, especially the smallest particles, is known to travel across continents. To determine just how much of a threat these tiny travelers pose, long-term studies are needed to further investigate how pathogens are distributed across dust particle size, and the distances these pathogens can travel and still survive.The dust storm that provided samples for Polymenakou et al. obscures the eastern Mediterranean Sea, 25 February 2006FiguresReferencesRelatedDetails Vol. 116, No. 3 March 2008Metrics About Article Metrics Publication History Originally published1 March 2008Published in print1 March 2008 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Religious gathering and the health threat

The annual pilgrimage to Makkah is the largest congregation of people in the world. It is a fertile area for the propagation of communicable diseases. This mass gathering unless controlled poses a dangerous health threat not only to Saudi Arabia but also to the countries from which pilgrims come from and the countries they transit in on their return journey. Meningococcal meningitis outbreak during the 1987 pilgrimage has exposed the Saudi authorities to a new form of communicable disease. It has necessitated the adoption of new measures both locally and internationally in order to combat such outbreaks. Although the Saudi health authorities are entrusted with providing optimal preventive and curative health services to the pilgrims, WHO and health authorities of other countries are also involved. This paper aims at elucidating the methods adopted by the Saudi health authorities during this event. It will also outline the measures to be adopted by various countries during such large religious gatherings and the vaccines strategies for travellers and their drawbacks.