ABSTRACT
Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Mass Vaccination/methods , Health Plan Implementation/methods , Meningococcal Infections/prevention & control , Meningococcal Infections/epidemiology , Seasons , Chile/epidemiology , Incidence , Disease Outbreaks/prevention & control , Age Distribution , Neisseria meningitidis, Serogroup W-135 , Vaccination CoverageABSTRACT
We describe a group of 3 cases of invasive meningococcal disease that occurred in a military training camp in April 2011. All three patients were hospitalized. Ultimately, two patients recovered and one died. One patient had meningitis, one patient had septicemia and meningitis, and the other had no definite septicemia or meningitis. Neisseria meningitidis serogroup W-135 was detected in the serum and cerebrospinal fluid (CSF) of all patients by real-time polymerase chain reaction. In the one case of mortality, two strains were isolated from the patient's blood and CSF. Using multilocus sequence typing analysis, these strains were identified as a novel sequence type, ST-8912. Special attention is required for the meningococcal disease in military camp because the military personnels are in high risk of contact transmission.
Subject(s)
Humans , Male , Young Adult , DNA, Bacterial/blood , Electrophoresis, Gel, Pulsed-Field , Meningitis/complications , Military Personnel , Multilocus Sequence Typing , Neisseria meningitidis, Serogroup W-135/genetics , Real-Time Polymerase Chain Reaction , Sepsis/complicationsABSTRACT
Background: During 2012 in Chile, there were 60 cases of serogroup W135 meningococcal disease, which accounts for 57.7% of identified serogroup cases. Aim: To describe main clinical features of patients with serogroup W135 meningococcal disease confirmed in 2012. Material and Methods: Descriptive study of case series based on retrospective review of medical records. Results: Male patients represented 61.7% and 46.7% were children under 5 years. At first clinical attention, 3.4% of patients were suspected of meningococcal disease, while 83.3% had meningococcemia as final diagnosis. Also at first attention, the most common symptoms or clinical signs were fever ≥ 38.0° C (60.3%), cold symptoms (52.5%), and nausea or vomiting (46.7%). Meningeal signs had a low frequency (8.7%). Diarrhea was the second most common symptom found among deceased patients (55.6%) and statistically higher than survivors (26.8%; p = 0.034). Six cases reported with sequelae: limb amputation, hearing loss or neurological damage, and mortality was 31.7%. Discussion: In 2012, serogroup W135 meningococcal disease reported high mortality, atypical clinical presentation, low initial meningococcal disease diagnosis, and a high number of cases with poor clinical course.
Introducción: En el año 2012 en Chile, se presentaron 60 casos de enfermedad meningocóccica (EM) causadas por serogrupo W135, que representa 57,7% de los casos seroagrupables. Objetivo: Describir las características clínicas de los casos de EM por serogrupo W135 confirmados durante el año 2012. Material y Métodos: Estudio descriptivo, de series de casos basada en la revisión de las fichas clínicas. Resultados: El 61,7% de los casos fueron varones y 46,7% tenía menos de 5 años. En la primera consulta, 3,4% tuvo sospecha de EM, en tanto 83,3% tuvo diagnóstico final de meningococcemia. En la primera consulta, los síntomas y/o signos más frecuentes fueron fiebre ≥ 38,0°C (60,3%), cuadro catarral respiratorio (52,5%) y náuseas y/o vómitos (46,7%). Mientras que los signos de irritación meníngea se presentaron en 8,7%. En los fallecidos la diarrea fue el segundo síntoma más frecuente (55,6%), y estadísticamente superior respecto de los sobrevivientes (26,8%; p = 0,034). Seis casos presentaron secuelas: amputaciones de extremidades, hipoacusia o daño neurológico y la letalidad fue de 31,7%. Discusión: la EM por el serogrupo W135 en el año 2012, tuvo una elevada letalidad, presentación clínica inespecífica, sospecha diagnóstica inicial baja y un alto número de casos cursaron con una mala evolución.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Meningococcal Infections/microbiology , /isolation & purification , Chile/epidemiology , Meningococcal Infections/diagnosis , Meningococcal Infections/drug therapy , Meningococcal Infections/epidemiologyABSTRACT
The epidemiologic behavior of the Invasive Meningococcal Disease (IMD) in Chile has changed. At the end of 2011, the W135 serogroup belonging to the hypervirulent clone ST-11 emerged. It affected diverse countries of the world, after the Mecca pilgrimage in 2000. In Chile, there have been 133 IMD cases during 2012. These figures represent an incidence of 0.7 per 100,000 inhabitants, which is 30% higher than expected. Eighty eight percent of cases were confirmed by the National Reference Laboratory at the Chilean Public Health Institute. The serogroup was determined in 103 strains and 58% belonged to the W135 serogroup, surpassing for the first time the B serogroup (37%). The Metropolitan Region concentrated 80% of these cases, and the remaining 20% affected other seven regions of the country. Forty seven percent of cases corresponded to children less than 5 years of age. The predominant clinical presentation of the W135 serogroup was a sepsis in 67% of cases. The fatality ratio of IDM during 2012 was 27%, the highest in the past 20 years. With this information, the Chilean Ministry of Health decreed a sanitary alert and implemented an integrated approach to control and prevent W-135 IDM, denominated "W-135 Action Plan".
Subject(s)
Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Meningococcal/epidemiology , /classification , Chile/epidemiology , Electrophoresis, Gel, Pulsed-Field , Epidemiological Monitoring , Incidence , Meningitis, Meningococcal/diagnosis , Meningitis, Meningococcal/microbiology , Multilocus Sequence Typing , /genetics , SerotypingABSTRACT
Objective To evaluate the immunogenic stability and hereditary stability of Neisseria meningitides serogroup W135/Y[CMCC(B)29037/CMCC(B)29028]within all the passages,which isolated from china.Methods The toxicity of the 3rd,5th,10th,15th,20th,25th and 30th passage of the Neisseria meningitidis was assayed in mice.Serological detection and biochemical detection were measured,and immunized mice subcutaneously.The antigeeicity of each passage of Neisseria meningitides serogroup W135/Y were measured by serum bactericidal test and the indirect ELISA.With the 30 passage of Neisseria meningitides serogroup W135/Y,the effect to the encephalic tissue was measured in mice.Fermented the Neisseria meningitides serogroup W135/Y with 30 passage and purified the capsular polysaccharide,then analyzed the quality respectively.Results The LD50 of the strains CMCC(B)29037/29028 of each passage was low(LD50 ≥ 109),and all the 30logical detection and all the 30 passage of the two strains were half in the tube agglutination.Glucose and maltose fermentation test were positive.Fructose,sucrose and lactose fermentation test were negative.The GMT of immunogenicity were 1114 and 2229 respectively and all the 30 passage were more than 640 and 1040 respectively.After Immunization with individual 30 passage of the Neisseria meningitides,the titer in serum bactericidal assay(SBA)and indirect ELISA were no difference.The capsular polysaccharide purified from Neisseria meningitides serogroup W135/Y met the quality standard.Conclusion Neisseria meningitides serogroup W135/Y,CMCC(B)29037/29028,used in the manufacture of the meningococcal conjugate vaccine,are stable in the toxicity,antigenicity,immunogenicity.Serological detection and biochemical detection are qulified,and the capsular polysaccharide has met the quality standard.
ABSTRACT
Neisseria meningitidis retains its ability to cause endemic and hiperendemic disease in human population living in any environment, as well as localized outbreaks and massive epidemics in civilians and military personnel. In Rio de Janeiro it has been reported in the 1990s as prolonged outbreak of serogroup B and at least one epidemic of serogroup C was well defined, both demanding quick action by the Public Health authorities. We report here the emergence of serogroup W135 meningococcal disease causing endemic and case cluster in Rio de Janeiro during the first years of this new century.
Subject(s)
Adult , Child , Humans , Disease Outbreaks , Meningococcal Infections , Brazil/epidemiology , Incidence , Meningococcal Infections/epidemiology , Meningococcal Infections/microbiologyABSTRACT
This study was performed to determine the incidence and serogroups of meningococcal disease in the Korean Army. From August 2000 to July 2001, we identified prospective cases in the Korean Army. Meningococcal disease was confirmed by isolation of Neisseria meningitidis or detection of its antigen by latex agglutination from cerebrospinal fluid (CSF) or blood. Polymerase chain reactions (PCRs) were performed in the crgA gene to identify N. meningitidis regardless of its serogroup, and then in orf-2 (serogroup A) and siaD (serogroups B, C, Y, and W135) respectively for serogroup prediction. During the study period, twelve patients (four meningitis and eight septicaemia) were identified. The annual incidence was 2.2 per 100,000 (95% confidence interval, 1.3-3.8) among 550,000 private soldiers. Latex agglutinations were positive to A/C/Y/W135 polyvalent latex, but not to B latex in all patients. PCRs of crgA gene were positive in ten patients, whose samples (2 isolates from CSF, 2 CSFs, and 6 sera) were stored. In PCRs for serogroup prediction, one isolate was serogroup A, and one isolate and two sera were serogroup C. The need for meningococcal vaccination would be considered in the Korean Army through the cost-benefit analysis based on the result of this study.