Advances in meningococcal polysaccharide conjugate vaccine research / 中国生物制品学杂志

@#Meningococcal polysaccharide conjugate vaccine is basically produced by chemical combination,and the most commonly used method is amide condensation reaction.Because of the covalent bonds between polysaccharide and protein,the prepared conjugate vaccine has high stability and good technical advantages,which plays an important role in the prevention of meningococcal related diseases.The vaccine can be applied to the immunization of young children under 2years old,and has more lasting protective effect.In this paper,the factors influencing the preparation of meningococcal polysaccharide conjugate vaccine,the binding mode of polysaccharide and carrier protein,the present situation at home and abroad and the existing problems in the preparation process were reviewed.

Development and verification of chemical chromogenic method for determination of residual cetyltrimethyl ammonium bromide content in ACYW135 meningococcal polysaccharide stock solution / 中国生物制品学杂志

@#Objective To develop and verify a chemical choromogenic method for the determination of residual cetyltrimethylammonium bromide(CTAB)content in ACYW135 meningococcal polysaccharide stock solution. Methods A chemical chromogenic method was developed for the determination of residual CTAB content by using titan yellow as chromogenic reagent,and verified for the linear range,intermediate precision and accuracy. ACYW135 meningococcal polysaccharide stock solution were determined for residual CTAB content by the developed method. Results The CTAB reference at concentrations of 4. 0～10. 0 μg/mL showed good linear relationship to A_(500),with a R~2 value of more than 0. 990. The recovery rates of CTAB standard at concentrations of 5. 0,7. 0,and 9. 0 μg/mL were all within 95% ～ 110% in six repeated tests,with the CV values of determination results of less than 10%. All the residual CTAB contents in four batches of meningococcal polysaccharide stock solutions were less than 8. 0 μg/mL. Conclusion The chemical chromogenic method showed good linearity,intermediate precision and accuracy,which might be used for the determination of residual CTAB content in ACYW135 meningococcal polysaccharide stock solution.

Meningite bacteriana: uma revisão / Bacterial meningitis: a review

A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.

Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.

Historia de la meningitis bacteriana en Cuba: siglo XIX al XXI

Introducción: La meningitis bacteriana aún constituye un importante problema de salud mundial. En Cuba hay limitadas investigaciones con una perspectiva histórica de esta temática. Objetivo: Describir el comportamiento de la meningitis bacteriana en Cuba (siglo XIX-XXI). Material y Métodos: Estudio descriptivo (corte histórico) entre finales de 1800 y 2017, utilizando el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: La primera alusión a la meningitis bacteriana en Cuba data de 1877. También se sugiere su probable importación por el ejército de ocupación norteamericano en 1899. En 1901 se aisló el meningococo de Weichselbaum del líquido cefalorraquídeo, lo que constituye, probablemente, su primera notificación en Cuba. Iniciado el siglo XX, se reportan casos aislados y brotes hasta 1976 cuando inicia la mayor epidemia de Enfermedad Meningocócica (serogrupos C y B). En 1979 se vacuna contra el C. En 1980 se implementa una vigilancia epidemiológica especial. Se desarrolla la vacuna cubana VA-MENGOC-BC® (1984) que se usa masivamente (1987) y se contribuye al control, incluyéndose en el Programa Nacional de Inmunizaciones (1991). Haemophilus Influenzae pasa a ser la principal bacteria causante de meningitis bacteriana hasta 1999 en que se aplican vacunas (Vaxem-Hib® y QuimiHib®) y se controla. Su nicho ecológico es ocupado por neumococo hasta ahora. Conclusiones: Desde fines del siglo XIX hasta la segunda mitad del XX la meningitis bacteriana en Cuba se manifestaba como casos aislados y brotes. Durante y después de una gran epidemia, se implementan estrategias preventivas efectivas, incluidas dos vacunas cubanas contra estas enfermedades, que revierten el comportamiento a endemia muy baja hasta la actualidad.

Introduction: Bacterial meningitis remains an important health problem worldwide. In Cuba, there are limited research studies about this issue from a historical perspective. Objective: To describe the behavior of this disease in Cuba (19th - 21st centuries). Material and Methods: A descriptive historical study was carried out between the ends of 1800-2017, using the historical-logical method and a deductive-inductive analysis of multiple bibliographical sources. Development: The first reference to bacterial meningitis in Cuba was made in 1877. The probable introduction of the disease by the US occupation army in 1899 is also considered. In 1901, the meningococci of Weichselbaum was isolated from cerebrospinal fluid, which was probably it first report in Cuba. At the beginning of the 20th century, isolated cases and outbreaks were reported until 1976, when the biggest and larger invasive meningococcal disease began (serogroups C, B). Vaccination against serogroup C started in 1979. In 1980, a special epidemiological surveillance was implemented. The Cuban vaccine VA-MENGOC-BC® against the disease was developed in 1984, which was massively used in 1987. The vaccine contributed to the control of the disease and was included in the National Immunization Program in 1991. Haemophilus Influenzae became the main causative bacterial agent of meningitis until 1999, when the implementation of massive vaccination (Vaxem-Hib® and QuimiHib®) controlled disease. Up to the present, its ecological niche is occupied by pneumococci. Conclusions: From the end of the 19th century to the second half of the 20th century, bacterial meningitis in Cuba behaved as isolated cases and outbreaks. Effective preventive strategies were implemented during and after a huge epidemic, including Cuban vaccines against the disease, that pass on its behavior to a very low endemic disease up to the moment.

Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up

Objectives: To report our experience with endoscopicmanagement of vesicoureteral reflux (VUR) by injection of atissue bulking substance – Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction.Design: Retrospective analyses of case records.Setting: Pediatric Surgery department in a tertiary caregovernment Institute.Participants: 500 children (767 renal units) consecutivelyreferred to the out-patient department with vesicoureteral refluxnoted on micturating cysto-urethrogram (MCU) over a period of13 years (2004-2016).Intervention: Preoperative VUR grading and renal scars onradionuclide scans were documented. Dextranomer hyaluronicacid copolymer was injected through a cystoscope at thevesicoureteral junction as a day care procedure under shortanesthesia. Patients were followed (average duration 27.3 mo)with clinical assessment, periodic urine cultures and renal scans.Main outcome measure: Cessation of VUR and symptomaticrelief / clinical success postoperatively at 3 months.Results: Complete symptomatic relief was obtained in 482(96.4%) patients. In 681 units where MCU was available, 614(90%) units showed resolution of VUR.Conclusion: Endoscopic injection of tissue bulking substancesat vesicoureteric junction to stop VUR seems to be an effectiveintervention

Clinico-epidemiological profile of meningitis patients diagnosed at a tertiary care hospital in Mumbai

Introduction: Meningitis is an inflammatory disease of the leptomeninges, the tissues surrounding the brain and spinal cord. Recently improved awareness, extensively available antibiotics and vaccines can change the epidemiological pattern of the disease. Materials and methods: The present observational study was conducted in the Department of Medicine, Lokmanya Tilak Municipal Medical College and Hospital from February 2016 till August 2017. The study population consisted of 100 patients admitted with features of acute meningitis. All meningitis and meningococcemia cases diagnosed according to the clinical and/or laboratory criteria during the study period were included in the study. Demographic and clinical data of the patients were recorded. Results: Of all the patients included in the study, 38% were diagnosed as bacterial meningitis, 54% as tubercular meningitis and rest as viral meningitis. All patients presented with symptoms of fever and neck stiffness. Headache, vomiting and altered sensorium were other common complaints. Most common CT head findings were that of a basal meningeal enhancement (89%). CSF was clear in 62% of the patients and raised erythrocyte count was observed in 74% of the patients. Mean adenosine deaminase (ADA) of the CSF in the study population was 7.93 ± 6.24 IU/L, ranging from 1 to 43 IU/L. Mean CSF C-reactive protein (CRP) in the study was 5.83 ± 7.11 mg/L, ranging from 0 to 25 mg/L. Conclusion: Understanding the current and future trends in meningitis are needed to improve the quality of patient care and outcomes.

Immune effects of different forms of vaccines of meningococcus serogroup B outer membrane protein 0315 / 中国免疫学杂志

Objective:To evaluate preliminarily immunocompetence and immunoprotection of a NMB0315 nucleic acid vaccine,a recombinant protein vaccine and a nucleic acid vaccine plus a recombinant protein vaccine against Neisseria meningitidis serogroup B in mice, and to provide reliable experimental basis for further exploration of the effective immunization methods and pathways of NMB0315 vaccine. Methods:The NMB0315 nucleic acid vaccine [ pcDNA3. 1 (+)/NMB0315 ] and recombinant protein vaccine(pET-30a/NMB0315)were prepared. Female BALB/c mice were inoculated with a NMB0315 DNA vaccine followed by boosting with recombinant protein NMB0315 through intramuscular and intraperitoneal immunization respectively. Next, humoral immunologic response and cellullar immunologic response were detected in female BALB/c mice by ELISA. The survival rate of BALB/c mice was used to evaluate immunoprotection of the vaccines in mice. Results:Specific IgG,IgG1,IgG2a,and sIgA,induced by the NMB0315 DNA vaccine(pNMB0315-CpG),protein NMB0315 vaccine(rNMB0315-FA),NMB0315 DNA vaccine prime-protein boost at week 8, were detected by indirect ELISA,the A450 values were up to(0. 505±0. 042,0. 513±0. 022,0. 342±0. 017,0. 250±0. 015),(0. 823± 0. 061,0. 807±0. 045,0. 596±0. 027,0. 450±0. 028)and(0. 694±0. 053,0. 711±0. 032,0. 455±0. 021,0. 386±0. 024)respectively, which was significantly higher than the PBS control(P<0. 05). The antibody level of protein vaccine was significantly higher than the nucleic acid vaccine group and combined immunization group ( P<0. 05 ) . The stimulation index and IFN-γ level of combined immunization group were significantly higher than the protein vaccine group and nucleic acid vaccine group(P<0. 05). The bactericidal titer of nucleic acid vaccine group, protein vaccine group and combined immunization group reached 1 :64, 1 :128 and 1 :128 respectively,and the protection rates were 70%,95% and 80% respectively. The IgG2a/IgG1 ratios of the nucleic acid vaccine group, the recombinant protein vaccine group and the combined immunization vaccine group were all less than 1 at week 2, 4, 6, 8. Conclusion:The humoral immunity effects( including mucosal immune) induced by the NMB0315 vaccines form high to low were as follows:the recombinant protein vaccine group, the combined immunization vaccine group, the nucleic acid vaccine;and the cellular immune effects from high to low were as follows:the combined immunization vaccine group, the nucleic acid vaccine group, the recombinant protein vaccine group;The protection effects induced by the NMB0315 vaccines in BALB/c mice within 72 hours from high to low were as follows:the recombinant protein vaccine group, the combined immunization vaccine group, the nucleic acid vaccine group.

Immune effects of different forms of vaccines of meningococcus serogroup B outer membrane protein 0315 / 中国免疫学杂志

Objective:To evaluate preliminarily immunocompetence and immunoprotection of a NMB0315 nucleic acid vaccine,a recombinant protein vaccine and a nucleic acid vaccine plus a recombinant protein vaccine against Neisseria meningitidis serogroup B in mice, and to provide reliable experimental basis for further exploration of the effective immunization methods and pathways of NMB0315 vaccine. Methods:The NMB0315 nucleic acid vaccine [ pcDNA3. 1 (+)/NMB0315 ] and recombinant protein vaccine(pET-30a/NMB0315)were prepared. Female BALB/c mice were inoculated with a NMB0315 DNA vaccine followed by boosting with recombinant protein NMB0315 through intramuscular and intraperitoneal immunization respectively. Next, humoral immunologic response and cellullar immunologic response were detected in female BALB/c mice by ELISA. The survival rate of BALB/c mice was used to evaluate immunoprotection of the vaccines in mice. Results:Specific IgG,IgG1,IgG2a,and sIgA,induced by the NMB0315 DNA vaccine(pNMB0315-CpG),protein NMB0315 vaccine(rNMB0315-FA),NMB0315 DNA vaccine prime-protein boost at week 8, were detected by indirect ELISA,the A450 values were up to(0. 505±0. 042,0. 513±0. 022,0. 342±0. 017,0. 250±0. 015),(0. 823± 0. 061,0. 807±0. 045,0. 596±0. 027,0. 450±0. 028)and(0. 694±0. 053,0. 711±0. 032,0. 455±0. 021,0. 386±0. 024)respectively, which was significantly higher than the PBS control(P<0. 05). The antibody level of protein vaccine was significantly higher than the nucleic acid vaccine group and combined immunization group ( P<0. 05 ) . The stimulation index and IFN-γ level of combined immunization group were significantly higher than the protein vaccine group and nucleic acid vaccine group(P<0. 05). The bactericidal titer of nucleic acid vaccine group, protein vaccine group and combined immunization group reached 1 :64, 1 :128 and 1 :128 respectively,and the protection rates were 70%,95% and 80% respectively. The IgG2a/IgG1 ratios of the nucleic acid vaccine group, the recombinant protein vaccine group and the combined immunization vaccine group were all less than 1 at week 2, 4, 6, 8. Conclusion:The humoral immunity effects( including mucosal immune) induced by the NMB0315 vaccines form high to low were as follows:the recombinant protein vaccine group, the combined immunization vaccine group, the nucleic acid vaccine;and the cellular immune effects from high to low were as follows:the combined immunization vaccine group, the nucleic acid vaccine group, the recombinant protein vaccine group;The protection effects induced by the NMB0315 vaccines in BALB/c mice within 72 hours from high to low were as follows:the recombinant protein vaccine group, the combined immunization vaccine group, the nucleic acid vaccine group.

Sordera aguda y ataxia de origen vestibular en paciente con meningitis por Meningococo Serogrupo C

La meningitis bacteriana aguda es una emergencia infectológica ya que puede ocasionar secuelas graves o incluso la muerte. Es rara la presentación de este cuadro con sordera súbita y ataxia. Se presenta el caso de una adolescente del sexo femenino de 14 años, que presentó meningitis bacteriana por meningococo serogrupo C con ataxia vestibular y sordera súbita, que fue tratada con corticoides y pentoxifilina, además de antibióticos para la infección de base. La recuperación de la audición no fue adecuada y persistió con sordera e hipoacusia severa unilateral y ataxia vestibular persistente e inhabilitante.

Acute bacterial meningitis is an infectious emergency as it can lead to serious sequelae or even death. The presentation of this condition with sudden deafness and ataxia is rare. We present the case of a 14-year old female adolescent, who presented with vestibular ataxia and sudden deafness and was subsequently diagnosed with bacterial meningitis due to serogroup C meningococcus. She was treated with corticosteroids and pentoxifylline, in addition to antibiotics, for the baseline infection. Hearing recovery was not adequate; she persisted with severe deafness, unilateral hearing loss and persistent and disabling vestibular ataxia.

Phase variation of Opa proteins of Neisseria meningitidis and the effects of bacterial transformation.

Opa proteins are major proteins involved in meningococcal colonization of the nasopharynx and immune interactions. Opa proteins undergo phase variation (PV) due to the presence of the 5 -CTCTT-3 coding repeat (CR) sequence. The dynamics of PV of meningococcal Opa proteins is unknown. Opa PV, including the effect of transformation on PV, was assessed using a panel of Opa-deficient strains of Neisseria meningitidis. Analysis of Opa expression from UK disease-causing isolates was undertaken. Different opa genes demonstrated variable rates of PV, between 6.4 ×10–4 and 6.9 ×10–3 per cell per generation. opa genes with a longer CR tract had a higher rate of PV (r2=0.77, p=0.1212). Bacterial transformation resulted in a 180-fold increase in PV rate. The majority of opa genes in UK disease isolates (315/463, 68.0%) were in the ‘on’ phase, suggesting the importance of Opa proteins during invasive disease. These data provide valuable information for the first time regarding meningococcal Opa PV. The presence of Opa PV in meningococcal populations and high expression of Opa among invasive strains likely indicates the importance of this protein in bacterial colonization in the human nasopharynx. These findings have potential implications for development of vaccines derived from meningococcal outer membranes.

Study on the molecular size distribution and the structural characteristics of group B meningococcal cap-sular polysaccharides / 中华微生物学和免疫学杂志

Objective To investigate the molecular size distribution and the structure of group B me-ningococcal capsular polysaccharides for the development of vaccines .Methods The molecular size distribution of group B meningococcal capsular polysaccharides was analyzed by chromatography on a Sepharose CL -4B col-umn.The molecular weight of repeat units were measured by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS).The structural characteristics of group B meningococcal capsular polysaccharides were analyzed by nuclear magnetic resonance ( NMR) based on the chemical shift of all charac-teristic protons by using group C meningococcal capsular polysaccharides and sialic acid as the controls .Results The KD value of group B meningococcal capsular polysaccharides extracted from 15 strains were ranged from 0.60 to 0.76.The molecular weight of repeat units was 284, which was identical to the theoretical value .The group B meningococcal capsular polysaccharides were 2→8 linked homopolymers of sialic acid lacking O-acetyl groups.Conclusion The group B meningococcal capsular polysaccharides had lower molecular weights , which might result in their poor immunogenicity .The structure of group B meningococcal capsular polysaccharides could be quickly and accurately analyzed by NMR technology .

Meningococcal Disease and Quadrivalent MenACWY-CRM Vaccine (Menveo(R)) / 소아감염

Meningococcal Disease, manifesting as meningitis and septicemia, is a life-threatening bacterial infection that results in significant morbidity and mortality, particularly in childhood. Its epidemic potential and limited opportunities for clinical intervention due to its rapid course present unique public health and clinical challenges. Incidence is highest in infants and young children, with a secondary peak of risk in adolescents. Approximately 10% of cases are fatal and survivors can be left with serious and permanent sequelae including amputations, hearing loss and cognitive impairment. Transmission is only from human-to-human, by infected respiratory tract secretions or saliva and therefore crowding poses a tremendously elevated risk for disease development. Military recruits and university students are at high risk due to the high carriage rate in adolescents, their behavior patterns and close contact. Menveo(R) (Novartis Vaccines and Diagnostics), a novel quadrivalent meningococcal conjugate vaccine directed against meningococcal serogroups A, C, W-135 and Y, has been shown to be immunogenic and well tolerated in all age groups and was recently licensed for use in Korea. Recent cases and deaths among military recruits drew public attention to their elevated risk and the Korean government has recommended vaccination of all new military recruits. Many Korean students seek to attend school, university, or language institutes in countries where routine meningococcal vaccination is required - clinicians should be aware of such requirements to ensure that students are vaccinated prior to arrival in the destination country.

Carriage Rates and Serogroups of Neisseria meningitidis among Freshmen in a University Dormitory in Korea

PURPOSE: Neisseria meningitidis is a leading cause of bacterial meningitis in young adults. University students, especially those living in dormitories, have been known to be at increased risk of meningococcal disease. We performed a longitudinal study to determine the carriage rates of N. meningitidis and the changes thereof. MATERIALS AND METHODS: We recruited Inha University freshmen who were, at that time, admitted to a student dormitory. A pharyngeal swab was taken from all participant who were also asked to complete a questionnaire. This was repeated four weeks later. RESULTS: A total of 136 students were enrolled at the first culture. After four weeks, 128 students were enrolled, including 106 re-participants. The overall carriage rates changed from 11.8% to 14.1%. In analysis of the 106 re-participants, "visiting to pubs" was associated with carriage of N. meningitis for both the first (p=0.047) and second cultures (p=0.026). Serogroup C was found to be the most frequent serogroup (5 isolates), while 3 isolates were found from serogroup B. The most prevalent PorA types were P1.22,14-6 (4 isolates) and P1.19,15 (3 isolates). The DNA sequences of PorA VR2 were changed in 2 students during prolonged carriage. CONCLUSION: The meningococcal carriage rate among first year university students who resided in a dormitory did not significantly increase over 4-week interval between cultures, which is markedly different from those reported in Western studies. Close social contact appeared to be related with carriage. Our data also revealed diversity in PorA types, suggesting the possibility of rapid mutation of the PorA gene during the 4-week interval.

Prevención / Prevention

En la actualidad, se cuenta con un grupo de vacunas desarrolladas para la prevención de infecciones bacterianas, incluso para realizar profilaxis. En la década de los 80 del siglo XX apareció la primera vacuna contra Haemophilus influenzae tipo b que redujo y prácticamente eliminó la enfermedad invasiva por esta bacteria. A inicios del año 2000 se observó una dramática reducción de enfermedad invasiva por neumococo, gracias a la introducción de la vacuna PCV-7 contra este germen. Sin embargo, surgieron serotipos no incluidos en esta vacuna, por lo cual se desarrollaron la PHiD-CV 10 y la PCV-13, con 10 y 13 serotipos, respectivamente. En contra del meningococo se han desarrollado vacunas polisacáridas que han demostrado efectividad, así como las conjugadas que pueden ser monovalentes y tetravalentes. La quimioprofilaxis se indica en casos específicos que se explican en forma detallada en este capítulo

Nowadays, several vaccines have been developed for the prevention of bacterial infections, and also for prophylaxis. In the 80's of the twentieth century came the first vaccine against Haemophilus influenzae type b, which reduced and virtually eliminated invasive disease by this bacterium. In early 2000, there was a dramatic reduction in invasive pneumococcal disease, with the introduction of PCV-7 vaccine against this germ. However, there were serotypes not included in the vaccine, which was developed by the Phido-CV 10 and PCV-13, 10 and 13 serotypes, respectively. Against meningococcus, polysaccharide vaccines have been developed that have demonstrated effectiveness, as well as the conjugate vaccines, which may be monovalent and tetravalent. Chemoprophylaxis is indicated in specific cases that are reviewed in detail in this chapter

Clinical and Epidemiologic Features of Meningococcal Infections in Incheon, Korea / 감염과화학요법

BACKGROUND: Meningococcal diseases occur worldwide and there are several case reports and reports on carriage rates in Korean military personnel. However, there are only few data on meningococcal diseases in the civilian. This study was performed to determine the incidence, clinical features of meningococcal disease, and a pharyngeal carriage rate of meningococcus in nonmilitary persons in metropolitan Incheon, Korea. MATERIALS AND METHODS: Patients with meningococcal diseases were searched by the following methods: discharge diagnosis of 'meningococcal infection' or 'meningococcal meningitis' or 'meningococcal sepsis'; positive cases in bacterial culture of blood or cerebrospinal fluid (CSF); positive meningococcal antigen in CSF. Two university hospitals in Incheon were participated and medical records of the meningococcal infection were reviewed. A survey of pharyngeal carriage of N. meningitidis was done at a high school by throat culture. RESULTS: A total of 15 cases of meningococcal diseases were identified. Ten cases were from Inha University hospital from January 1997 to May 2004, and five cases were from Gacheon Medical School Gil hospital from January 2002 to May 2004. Neisseria meningitidis was isolated in 11 cases and the remaining 4 cases were diagnosed by detecting of meningococcal antigen. The minimal annual incidence rates of meningococcal infection in metropolitan Incheon city ranged from 0.077/ 100,000 to 0.192/100,000. Majority of the patients were under 15 years old and occurred between October to May. The diagnosis was meningitis in 14 patients and sepsis in one patient. Patient with sepsis died but all the other patients recovered.Two among five strains produced beta-lactamase. Throat cultures from 78 high school students showed Neiserria meningitidis in 6 (7.7%) students. CONCLUSION: Epidemiologic data and clinical features were similar to other reports from developed countries. However antimicrobial resistance rate may be higher. Further studies on meningococcal serogroup or sequence type, antimicrobial resistance, and prevalence of antibody against meningococcus are needed.

Clinical and Epidemiologic Features of Meningococcal Infections in Incheon, Korea / 감염과화학요법

BACKGROUND: Meningococcal diseases occur worldwide and there are several case reports and reports on carriage rates in Korean military personnel. However, there are only few data on meningococcal diseases in the civilian. This study was performed to determine the incidence, clinical features of meningococcal disease, and a pharyngeal carriage rate of meningococcus in nonmilitary persons in metropolitan Incheon, Korea. MATERIALS AND METHODS: Patients with meningococcal diseases were searched by the following methods: discharge diagnosis of 'meningococcal infection' or 'meningococcal meningitis' or 'meningococcal sepsis'; positive cases in bacterial culture of blood or cerebrospinal fluid (CSF); positive meningococcal antigen in CSF. Two university hospitals in Incheon were participated and medical records of the meningococcal infection were reviewed. A survey of pharyngeal carriage of N. meningitidis was done at a high school by throat culture. RESULTS: A total of 15 cases of meningococcal diseases were identified. Ten cases were from Inha University hospital from January 1997 to May 2004, and five cases were from Gacheon Medical School Gil hospital from January 2002 to May 2004. Neisseria meningitidis was isolated in 11 cases and the remaining 4 cases were diagnosed by detecting of meningococcal antigen. The minimal annual incidence rates of meningococcal infection in metropolitan Incheon city ranged from 0.077/ 100,000 to 0.192/100,000. Majority of the patients were under 15 years old and occurred between October to May. The diagnosis was meningitis in 14 patients and sepsis in one patient. Patient with sepsis died but all the other patients recovered.Two among five strains produced beta-lactamase. Throat cultures from 78 high school students showed Neiserria meningitidis in 6 (7.7%) students. CONCLUSION: Epidemiologic data and clinical features were similar to other reports from developed countries. However antimicrobial resistance rate may be higher. Further studies on meningococcal serogroup or sequence type, antimicrobial resistance, and prevalence of antibody against meningococcus are needed.

A Case of Meningococcal Meningitis with Complement 9 Deficiency / 소아과

Meningococcal disease is not rarely associated with abnormalities of the complement system. We experienced a case of C9 deficiency with meningococcal meningitis from a 12-year-old girl. Identification of complement deficiency has implications for management, including family studies, prophylaxis, vaccination, and altered threshold for infection screening and treatment.