Epidemiological and etiological analysis of two infantile cases of serogroup B epidemic cerebrospinal meningitis epidemics in Shandong Province, 2021 / 中华预防医学杂志

Two cases of epidemic situation of serogroup B meningitis in infants in Shandong Province in 2021 were investigated. Samples of cases and their close contacts were collected for isolation, culture and identification of Neisseria meningitides (Nm). The isolates were subjected to multi-locus sequence typing, outer membrane protein porA and fetA genotyping and drug sensitivity test. Two laboratory-confirmed outbreaks of serogroup B meningitis were reported from Yantai city and Linyi city. The indicated cases were infants aged 5 months and 2 months old respectively. They were not vaccinated with meningitis vaccine. Their epidemiological characteristics and clinical manifestations were similar and the prognosis was good. The same sequence type (ST) of serogroup B Nm strains as the indicated cases was detected in the samples of close family contacts, but without subsequent cases. Among them, Yantai strain was were identified as the type ST-8920, belonging to CC4821 clonal complex, and the genotypes of porA and fetA were p1.21-2, 23 and F3-1. Linyi strain was a new type, belonging to CC4821 clonal complex and the genotypes of porA and fetA were p1.20, 23 and F1-91. The above strains were resistant to penicillin, ciprofloxacin, levofloxacin and Chemitrim, and their sensitivity to cephalosporin decreased. Two cases of infant serogroup B epidemic were relatively rare in China, which were different from the epidemiological and pathogenic characteristics of other Nm serogroups in the past.

Carriage prevalence of Neisseria meningitidis in the Americas in the 21st century: a systematic review

Abstract Neisseria meningitidis is a bacterium that colonizes the human nasopharynx and is transmitted by respiratory droplets from asymptomatic or symptomatic carriers. Occasionally, the pathogen invades the mucosa and enters the bloodstream, causing invasive meningococcal disease, a life-threatening infection. While meningococcal colonization is the first step in the development of invasive disease, the risk factors that predict progression from asymptomatic to symptomatic status are not well-known. The present report aimed to describe the prevalence of N. meningitidis carriers throughout the Americas, emphasizing the risk factors associated with carrier status, as well as the most prevalent serogroups in each studied population. We conducted a systematic review by searching for original studies in the MEDLINE/PubMed, Embase, LILACS and SciELO databases, published between 2001 and 2018. Exclusion criteria were articles published in a review format, case studies, case control studies, investigations involving animal models, and techniques or publications that did not address the prevalence of asymptomatic carriers in an American country. A total of 784 articles were identified, of which 23 were selected. The results indicate that the highest prevalence rates are concentrated in Cuba (31.9%), the United States (24%), and Brazil (21.5%), with increased prevalence found among adolescents and young adults, specifically university students and males. The present systematic review was designed to support epidemiological surveillance and prevention measures to aid in the formulation of strategies designed to control the transmission of meningococci in a variety of populations and countries throughout the Americas.

Epidemic management in the African Meningitis Belt

The meningococcal meningitis cases are reported across the world. Nevertheless, large, frequent epidemics affect an exten-sive region of sub-Saharan Africa known as the "Meningitis Belt" which comprises of 26 countries from Senegal in the west to Ethiopia in the east

Control of meningitis in Sudan

Following the deployment implementation of mass preventive campaign with Conjugate-A vaccines [MenAfriVac] in Sudan in 2013, cases of meningococcal meningitis caused by Neisseria Meningitidis serogroup A [NmA] has decreased substantially in the country. However, concerns remains on the possibility of outbreaks caused by new sero-group particularly serogroup C

Preparedness for hajj

According to Islamic lunar calendar, hajj, the annual Muslim pilgrimage, is expected to be held this year in Saudi Arabia during the week of 21-26 September. In view of a number of public health events currently ongoing around the world from where the Muslim pilgrims would assemble in Saudi Arabia for the hajj, there an urgent need to scale up preparedness for a blessed hajj

Meningococcal disease in Sudan

In 2014, Sudan reported only 111 sus-pected cases of meningococcal meningi-tis including 2 deaths [CFR 2%]. None of the samples were tested positive for Neisseria Meningitidis of any sero-group especially sero-group A. The reported cases were distributed sporadically in some of the 494 sectors [sub-districts] of the 18 States in the country

Avaliação da resposta imunológica após vacinação ou infecção por Neisseria meningitidis / Evaluation of the immune response after vaccination or infection with Neisseria meningitidis

A doença meningocócica (DM) é, ainda hoje, um sério problema de saúde pública, estando associada a elevadas taxas de morbidade e letalidade no mundo. A DM evoca proteção imunológica persistente contra a doença em pessoas com sistema imunológico normal. Em contraste, a proteção induzida por vacinas meningocócicas sempre requer a administração de doses reforço (booster) da vacina. No Brasil, Neisseria meningitidis dos sorogrupos C (MenC) e B (MenB) são as principais causas de DM durante os últimos anos. Atualmente, não existe uma vacina universal contra o meningococo B (MenB). A infecção pelo vírus da imunodeficiência humana (HIV) tem sido apontada como um fator de risco para a mortalidade da DM. Um dos pilares do tratamento do HIV é a utilização de vacinas para doenças imuno-preveníveis. A vacina conjugada anti-MenC é frequentemente recomendada para crianças e adolescentes infectados pelo HIV no Brasil e em muitos outros países. Poucos estudos têm abordado os mecanismos pelos quais as vacinas meningocócicas geram e sustentam a memória imunológica. Os objetivos deste estudo foram: 1) avaliar a resposta de anticorpos bactericidas e de linfócito T (LT) CD4 de memória contra o meningococo após a infecção; 2) avaliar a resposta de anticorpos bactericidas e de LT CD4 de memória e linfócito B de memória (LBm) contra o meningococo após o booster da vacina cubana VA-MENGOC-BC® em voluntários imunizados há aproximadamente 17 anos; 3) investigar a resposta de anticorpos funcionais (bactericidas e opsonizantes) após imunização com a vacina conjugada anti-MenC (CRM197) em indivíduos infectados pelo vírus HIV. Após a infecção, 83% dos pacientes diagnosticados como tendo DM pelo teste de látex e/ou cultura tiveram títulos de anticorpos bactericidas protetores, mas não houve uma associação entre os títulos de anticorpos bactericidas e a concentração de imunoglobulina total específica...

Meningococcal disease (MD) is still a serious public health problem and is associated with high morbidity and mortality rates worldwide. MD evokes persistent immune protection against disease in people with normal immune systems. In contrast, protection induced by meningococcal always requires booster injections of the vaccine. In Brazil, Neisseria meningitidis serogroup C (MenC) and B (MenB) have been the main causes of MD for the past years. Currently, there is no universal vaccine against serogroup B. HIV infection has been implicated as a risk factor for the mortality of meningococcal disease. One of the cornerstones of HIV treatment is the use of vaccines for immunopreventable diseases. The anti-MenC conjugated vaccine is often recommended for children and adolescents infected with HIV in Brazil and many other countries. Few studies have addressed the mechanisms by which meningococcal vaccines generate and sustain immunological memory. The aims of this study were: 1) to evaluate the response of bactericidal antibody and memory CD4 T lymphocyte against meningococcus after infection; 2) to evaluate the bactericidal antibody response and memory T cells and memory B cells against meningococcal booster after the Cuban vaccine VA-MENGOC-BC® in volunteers immunized for about 17 years; 3) to investigate the functional antibody response (bactericidal and opsonizing) after immunization with anti-MenC conjugated vaccine (CRM197) in individuals infected with HIV. After infection, 83% of patients diagnosed as having DM by latex and/or culture test, had protective titers of bactericidal antibodies, but there was no association between the titers of bactericidal antibodies and the total specific immunoglobulin concentration and an increase in frequency of TCM (median of 15%) activated mainly after stimulation with MenC strain...

Emergencia de la cepa W135 causante de enfermedad meningocócica invasora en Chile 2012 / Emergence of W135 meningococcal serogroup in Chile during 2012

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".

Enfermedad meningocócica: epidemiología, diagnóstico y vacunación / Meningococcal disease: epidemiology, diagnosis and vaccination

La enfermedad meningocócica invasiva causada por N. meningitidis es un problema global de salud pública, por su alta morbilidad y mortalidad. Esta patología es causada en su mayoría por los serogrupos A,B,C, W-135 e Y. La prevención mediante la vacunación es la mejor herramienta para disminuir la carga mundial de esta enfermedad. Las vacunas no conjugadas que toman como base solo el polisacárido externo, aun cuando son beneficiosas en epidemias, producen pobre inmunogenicidad a largo plazo en los niños menores de dos años de edad, que representan la población de mayor riesgo. Las vacunas de nueva generación, en donde el polisacárido es conjugado con proteína transportadoras, producen respuestas inmune en niños menores de 2 años, lo cual podría producir una reducción importante de la enfermedad en esta población de alto riesgo. Las nuevas técnicas de detección están constituyendo a mejorar el pronóstico de la enfermedad, al permitir un diagnóstico más temprano y específico, conducentes a un tratamiento más oportuno. La creación de vacunas que confieran una protección más amplia, especialmente contra el serogrupo B, y protejan a la población en mayor riesgo, sigue siendo un reto...

Impacto da vacinação contra o meningococo c na ocorrência de doença meningocócica em hospital especializado / The impact of vaccination against meningococcus c on the occurrence of meningococcal disease in a specialized hospital / El impacto de la vacunación contra el meningococo c en la ocurrencia de la enfermedad meningocócica en un hospital especializado

A Doença Meningocócica (DM) constitui-se um grave problema de saúdepública devido a sua alta letalidade. O objetivo deste estudo é descrever a ocorrência da DM em um serviço de referência cinco anos antes (2005 a 2009) e um ano e oito meses (2011 a agosto 2012) após a campanha vacinal em Salvador, observando possíveis alterações no perfil epidemiológico. Trata-se de um estudo descritivo, utilizando dados secundários coletados no Núcleo de Vigilância Epidemiológica do Hospital Couto Maia, com análise retrospectiva dos casos de DM no período estudado. A amostra foi formada por 488 pacientes, tendo sido amaior parte deles internados no período pré-vacinal (71por cento). Os resultados apontam uma queda na frequência importante da doença nas faixas etárias de 0 a 5 anos e entre 20 e 24 anos, 90por cento e 85por cento, respectivamente. O estudo obteve resultados compatíveis com estudos prévios realizados no Reino Unido e em Quebec, evidenciando diminuição da frequência deDM nas faixas etárias vacinadas contra o meningococo C. Concluiu-se que a vacinação contra o meningococo C, mesmo sendo restrita a algumas faixas etárias, pode constituir importante ferramenta para redução dos casos da doença.

The Meningococcal Disease (DM) constitutes a serious public health problem due to its high lethality. The aim of this study is to describe the occurrence of DM in a reference service five years before (2005-2009) and one year and eight months (2011 to August 2012) after the vaccination campaign in Salvador, observing possible changes in the epidemiological profile. This is a descriptive study using secondary data collected at the Center for Epidemiological Surveillance of Hospital Couto Maia, with retrospective analysis of cases of DM during the study period. The sample consisted of 488 patients, who were mostly admitted tothe pre-vaccine period (71percent). The results indicate a significant decrease in the frequency of the disease in the age groups 0-5 years and between 20 and 24 years, 90percent and 85percent, respectively. The study obtained results consistent with previous studies conducted in the UK and in Quebec,showing a reduction in the frequency of DM in the age vaccinated against meningococcal C. It was concluded that vaccination against meningococcal C, despite being restricted to certain age groups can be an important tool for reducing cases of meningococcal disease.

La enfermedad meningocócica (EM) constituye un grave problema de salud pública debido a su alta letalidad. El objetivo de este estudio es describir la ocurrencia de EM en un servicio de referencia, durante el periodo de 2005 a 2009, y en un periodo más reciente, de 2011 a agosto de 2012, después de la campaña de vacunación en Salvador, observando los posibles cambios en el perfil epidemiológico. Se trata de un estudio descriptivo utilizando datos secundarios recolectados en el Centro de Vigilancia Epidemiológica del Hospital Couto Maia, con el análisis retrospectivo de los casos de DM durante el período de estudio. La muestra estuvo constituida por 488 pacientes, en su mayoría (71por ciento), ingresados en el periodo anterior a la vacuna. Los resultados indican una disminución significativa en la frecuencia de la enfermedad en los grupos de edad 0-5 años y entre 20 y 24 años, es decir, 90por ciento y 85por ciento, respectivamente. Los resultados obtenidos son compatibles con estudios previos realizados en el Reino Unido y en Quebec, mostrando unareducción de la frecuencia de EM en los grupos de edad vacunados contra el meningococo C. Se concluye que la vacunación contra el meningococo C, a pesar de su restricción a ciertos grupos de edad, puede ser una herramienta importante para reducir los casos de dichaenfermedad

Meningococcal disease in South Sudan

An outbreak of meningococcal meningi-tis has been reported from Malakal County in Upper Nile state of South Sudan. As of 17 May 2013, a total of 132 suspected cases including 5 deaths [CFR: 3.7%] have been reported from this lo-cality in Upper Nile State [Please see the chart]. Most of the reported cases were between the age of 4 and 40 years old

Análise crítica das recomendações do uso das vacinas meningocócicas conjugadas / A critical appraisal of the recommendations for the use of meningococcal conjugate vaccines

OBJETIVOS: Analisar a epidemiologia da doença meningocócica no Brasil e o impacto que as recentes evidências acumuladas com a incorporação das vacinas meningocócicas C conjugadas nos programas de imunização podem ter nas diferentes estratégias de uso dessas vacinas. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO e LILACS no período de 2000 a 2011. SÍNTESE DOS DADOS: No Brasil, a doença meningocócica é endêmica, com ocorrência periódica de surtos. Os maiores coeficientes de incidência ocorrem em lactentes, sendo o sorogrupo C responsável pela maioria dos casos, motivando a introdução da vacina meningocócica C conjugada no Programa Nacional de Imunizações, em 2010, para crianças menores de 2 anos. A introdução das vacinas meningocócicas C conjugadas nos programas de imunização na Europa, Canadá e Austrália mostrou-se efetiva, com dramática redução na incidência de doença causada pelo sorogrupo C, não apenas nos vacinados, mas também em não vacinados. A efetividade em longo prazo dessas vacinas mostrou-se dependente de uma combinação de persistência de anticorpos, memória imunológica e proteção indireta. Recentes evidências indicando que a persistência de anticorpos não é duradoura em crianças pequenas imunizadas e que a memória imunológica não é rápida o suficiente para protegê-las contra a doença enfatizam a importância da proteção indireta para manutenção da população protegida. CONCLUSÕES: A rápida queda de títulos de anticorpos em crianças vacinadas nos primeiros anos de vida sugere a necessidade de incorporarmos doses de reforço antes da adolescência, especialmente em locais como o Brasil, onde ainda não contamos com o efeito da proteção indireta da população.

OBJECTIVES: To assess the epidemiology of meningococcal disease (MD) in Brazil and the impact that recent evidence and lessons learned from the introduction of meningococcal C conjugate (MCC) vaccines into immunization programs may have on different strategies of vaccine use. SOURCES: Non-systematic review of the MEDLINE, SciELO and LILACS databases covering the period from 2000 to 2011. SUMMARY OF THE FINDINGS: Meningococcal disease is endemic in Brazil, with periodic occurrence of outbreaks. Most cases are associated with serogroup C and the highest incidence rates are observed in infants, encouraging the introduction of MCC vaccine in the National Immunization Program in 2010 for children under 2 years old. The introduction of MCC vaccines into immunization programs in Europe, Canada and Australia proved to be effective, with dramatic reduction in the incidence of serogroup C meningococcal disease, not only in the vaccinated, but also in the unvaccinated individuals. Long-term effectiveness of MCC vaccines was dependent on a combination of antibody persistence, immunologic memory and herd protection. Recent evidence indicating that antibody persistence is not long-lasting in young immunized children, and that immunologic memory is not fast enough to protect them against the disease, emphasize the importance of herd protection to maintain the population protected. CONCLUSIONS: The rapid decline of antibody titers in children vaccinated in the first years of life suggests the need to incorporate booster doses before adolescence, especially in locations like Brazil, where the immunization program did not incorporate catch-up campaigns including adolescents, lacking the herd immunity effect.

Epidemiological profile of meningococcal disease in the State of Minas Gerais and in the Central, North, and Triângulo Mineiro regions, Brazil, during 2000-2009 / Perfil epidemiológico da doença meningocócica, no Estado de Minas Gerais e nas regiões Centro, Norte e Triângulo Mineiro, Brasil, de 2000 a 2009

INTRODUCTION: Infection by Neisseria meningitidis, termed as meningococcal disease, can cause meningococcal meningitis and septicemia with or without meningitis. Meningococcal disease is endemic in Brazil and has a high potential to cause large-scale epidemics; therefore, it requires the immediate notification of cases to the Information System for Notifiable Diseases (SINAN) in Brazil. The aim of this study was to describe an epidemiological profile using data from notified and confirmed cases in the State of Minas Gerais, Brazil, from January 2000 to December 2009, obtained from the investigation records of individuals with meningitis registered with SINAN. METHODS: This was a retrospective, population-based study. Descriptive analysis of the data was made using the simple and relative frequencies of the categorical variables in the investigation records. RESULTS: There were 1,688 confirmed patients in Minas Gerais of which 45.5% lived in the Central, North, and Triângulo Mineiro regions. The highest frequencies of cases were in the 1-4-years age group (26.3%), males (54.7%), caucasian (36.4%), and lived in an urban area (80%). In the patients with specified education, 650 (60.9%) patients had secondary education. Serogrouping of meningococci had been performed in 500 (29.6%) patients by age and gender; 285 (57%) belonged to serogroup C, 67 (13.4%) were in the 1-to 4-years age group, and 168 (33.6%) were male. CONCLUSIONS: The epidemiological profiles of patients in the Central, North, and Triângulo Mineiro regions were not significantly different from the profile of patients in Minas Gerais.

INTRODUÇÃO: A infecção por Neisseria meningitidis, denominada doença meningocócica, pode causar meningite meningocócica e meningococcemia com ou sem meningite. A doença meningocócica é endêmica no Brasil; no entanto, o alto potencial de causar epidemias e letalidade elevada impõe a notificação imediata dos casos ao Sistema de Informação de Agravos de Notificação (SINAN) do Brasil. O objetivo deste estudo foi descrever o perfil epidemiológico, utilizando registros de casos notificados e confirmados no Estado de Minas Gerais, Brasil, de janeiro de 2000 a dezembro de 2009, obtidos a partir da ficha individual de investigação de meningites registrada no SINAN. M ÉTODOS: Trata-se de um estudo retrospectivo, de base populacional. Foram realizadas análises descritivas dos dados, a partir das frequências simples absolutas e relativas para as variáveis categóricas da ficha de investigação e teste qui-quadrado. RESULTADOS: Houve 1.688 casos confirmados em Minas Gerais, dos quais 45,5% residiam no centro, norte e Triângulo Mineiro. As maiores frequências foram nos pacientes do grupo etário de 1 a 4 anos (26,3%), sexo masculino (54,7%), brancos (36,4%) e residiam em zona urbana (80%). Dos casos com escolaridade especificada, 650 (60,9%) casos cursaram ensino médio completo. Foram sorogrupados e classificados segundo idade e sexo 500 (29,6%) casos, e desses 285 (57%) foram sorogrupo C, 67 (13,4%) da faixa etária de 1 a 4 anos e 168 (33,6%) do sexo masculino. CONCLUSÕES: O perfil epidemiológico dos casos nas regiões centro e norte e Triângulo Mineiro não apresentaram diferenças importantes comparado ao perfil dos casos de Minas Gerais.

Situación epidemiológica y cumplimiento de indicadores de la vigilancia de la enfermedad meningocócica / Epidemiologic status and fulfillment of surveillance indicators of meningococcal disease

La enfermedad meningocócica es de distribución mundial y presenta brotes de gran magnitud en el cinturón de la meningitis (África Subsahariana). A partir de 2001, la tendencia de la enfermedad en Chile disminuye, cambiando su presentación a baja endemia. Así, en el 2010 presentó una incidencia de 0,5 por cien mil habitantes. El grupo más afectado son los menores de 5 años, y de éstos, los menores de un año. Además, desde 1994 el serogrupo C fue considerado reemergente, produciendo brotes en 1999 y 2002. Esta enfermedad es de vigilancia universal e inmediata, cuyo sistema de vigilancia contempla indicadores de calidad, que evalúan los componentes clínico, epidemiológico y laboratorio. Este artículo analiza la situación epidemiológica de la enfermedad en Chile y su tendencia mundial, así como el fundamento para el cumplimiento de indicadores que requieren una respuesta oportuna frente al caso sospechoso sin esperar la confirmación de laboratorio.

Meningococcal disease has worldwide distribution and present large-scale outbreaks on the meningitis belt (sub-Saharian Africa). Since 2001, disease trend in Chile decreases, changing its presentation to low endemicity. Thus, 2010 registered an incidence of 0.5 per 100 thousand habitants. The most affected group was < 5 years old, specifically < 1 year old. Besides,since 1994, serogroup C was considered re-emergent, causing outbreaks in 1999 and 2002. This disease considersimmediate and universal surveillance and comprise quality indicators that assess clinical, epidemiological and laboratory components. This article analyze the epidemiological situation in Chile and its world trend, also the fundamental basis for indicator fullfilments that requires a fast response against a suspected case, without waiting for laboratory confirmation.