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.

Research progress on immunogenicity evaluation of serogroup B meningococcal vaccine / 中华预防医学杂志

Epidemic cerebrospinal meningitis (meningococcal meningitis) is an acute respiratory infectious disease with high mortality and serious sequelae. Meningococcal vaccine is an effective measure to prevent and control meningococcal meningitis. At present, group B meningococcal meningitis has become the main prevalent serum group in the world, including China. Meningococcal ACYW and other vaccines are mainly composed of capsular polysaccharides, while the main component of group B meningococcal vaccine is protein, including outer membrane vesicles (OMV) and recombinant protein vaccine. The methods for evaluating the immunogenicity of group B meningococcal vaccine include hSBA and alternative methods such as meningococcal antigen typing system (MATS), flow cytometric meningococcal antigen surface expression assay (MEASURE), genetic meningococcal antigen typing system (gMATS) and bexsero antigen sequence type (BAST). The evaluation of vaccine immunogenicity is the basis of vaccine development and clinical trial research, However, at present, there is no group B meningococcal vaccine in China. Therefore, in this paper, the research progress of immunogenicity evaluation of group B meningococcal vaccine has been reviewed, in order to provide technical guidance for the research and development of group B meningococcal vaccine, immunogenicity evaluation and clinical trial research in China.

Pediatric bacterial meningitis and meningococcal disease profile in a Brazilian General Hospital

Abstract Objective To evaluate the clinical and epidemiological profile of bacterial meningitis and meningococcal disease in pediatric patients admitted to a Brazilian Secondary Public Hospital. Methods A descriptive observational study was conducted. Microbiologically proven bacterial meningitis or meningococcal disease diagnosed from 2008 to 2018 were included. Results A total of 90 patients were diagnosed with proven bacterial meningitis. There were 64 confirmed cases of meningococcal disease. The prevalence was higher in boys (n=38), median age 30 months (1-185). The main clinical manifestations were: meningococcal meningitis (n=27), meningococcemia without meningitis (n=14), association of meningococcemia with meningitis (n=13), and fever without a known source in infants (n=7).Admissions to intensive care unit were necessary for 45 patients. Three deaths were notified. Serogroup C was the most prevalent (n=32) followed by serogroup B (n=12).Pneumococcal meningitis was identified in 21 cases; out of the total, 10 were younger than two years. The identified serotypes were: 18C, 6B, 15A, 28, 7F, 12F, 15C, 19A and 14. Pneumococcal conjugate 10-valent vaccine covered four of the nine identified serotypes.Haemophilus influenzae meningitis serotype IIa was identified in three patients, median age 4 months (4-7). All of them needed intensive care. No deaths were notified. Conclusion Morbidity and mortality rates from bacterial meningitis and meningococcal disease remain high, requiring hospitalization and leading to sequelae. Our study observed a reduced incidence of bacterial disease over the last decade, possibly reflecting the impact of vaccination.

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.

Estudio de tolerancia local de la vacuna antimeningocóccica VA-MENGOC-BC® en ratas Sprague Dawley. Evaluación a los 24 y 36 meses en estante / Local tolerance study of the VA-MENGOC-BC® antimeningococcal vaccine in Sprague Dawley rats. Evaluation at 24 and 36 months of shelf

La meningitis meningocóccica continua siendo un problema de salud en diferentes países y para la prevención de esta enfermedad se han obtenido diferentes vacunas. La vacuna VA-MENGOC-BC® ha constituido ser eficaz y segura en la prevención de la meningitis meningocóccica contra los serogrupos B y C. Esta ha demostrado buena estabilidad en el tiempo sin cambiar su calidad como producto; fue conservada a estante durante 24 y 36 meses a temperaturas de 4 a 8 °C. Se evaluó su posible potencial toxicológico a través de un estudio de tolerancia local en ratas Sprague Dawley para extender su vida útil. Los animales inmunizados se observaron diariamente para evaluar síntomas locales y sistémicos de toxicidad. Se realizaron evaluaciones del peso corporal, consumo de agua y alimento, termometría, musculometría e irritabilidad dérmica por el método de Draize. Se realizaron estudios anatomopatológicos periódicos para observar posibles efectos adversos. No se observaron síntomas de toxicidad ni muertes. No se encontraron diferencias entre los grupos experimentales en cuanto al peso corporal, el consumo de agua y de alimentos, no se evidenció fiebre, ni irritabilidad local. Anatomopatológicamente a nivel del punto de inoculación se observaron procesos granulomatosos de tipo macrofágicos característicos en las vacunas que contienen hidróxido de aluminio. Estos resultados permitieron concluir que la vacuna VA-MENGOC-BC® que permaneció en estante durante 24 y 36 meses no evidenció efectos adversos locales, ni sistémicos en las ratas(AU)

Meningococcal meningitis continues to be a health problem in different countries and different vaccines have been obtained for the prevention of this disease. VA-MENGOC-BC® vaccine has been effective and safe in the prevention of meningococcal meningitis against serogroups B and C. This has shown good stability over time without changing its quality as a product; it was stored on a shelf for 24 and 36 months at temperatures of 4 to 8 °C. Their possible toxicological potential was evaluated through a local tolerance study in Sprague Dawley rats. Immunized animals were observed daily to evaluate local and systemic toxicity symptoms. Body weight, water and feed intake, thermometry, musculometry were performed and dermal irritability by the Draize method. Anatomopathological studies to observe possible adverse effects were made. No symptoms of toxicity or deaths were observed. No differences were found between the experimental groups in terms of body weight, water and food consumption, no fever or local irritability was evident. Anatomopathologically no lesions of diagnostic value were observed, at the site of inoculation, granulomatous processes of macrophagic type characteristic in vaccines containing aluminum hydroxide were observed. These results allowed us to conclude that the VA-MENGOC-BC® vaccine that remained on the shelf for 24 and 36 months did not show any local or systemic effects in rats(AU)

Efficacy, safety, and cost-effectiveness of meningococcal vaccines / 中华预防医学杂志

Meningococcal meningitis is an acute, severe respiratory infectious disease caused by Neisseria meningitidis. Immunization with meningococcal vaccine is the most effective measure to control and prevent transmission of meningococcal meningitis. Meningococcal vaccines in the Chinese market include meningococcal polysaccharide vaccine, meningococcal polysaccharide conjugate vaccine, and a combined vaccine containing meningococcal polysaccharide conjugate vaccine. This article reviews research progress on the efficacy, safety, and cost-effectiveness of meningococcal vaccines, particularly in the Chinese market, to support appropriate use of the various meningococcal vaccines for preventing meningococcal meningitis.

Doença meningocócica invasiva nas capitais da Região Sul do Brasil: características e tendências / Invasive meningococcal disease in the capitals of the Southern Region of Brazil characteristics and trends

Objetivos: Analisar a tendência, descrever mudanças no comportamento da doença meningocócica invasiva (DMI) e estimar o impacto da vacina conjugada do meningococo C (VCMC) nas capitais da região Sul do Brasil, no período de 1991 a 2015, assim como, investigar as características sociodemográficas, econômicas e de intervenções tecnológicas associadas aos casos pertencentes a cluster da doença no município de Curitiba (PR), no período de 2001 a 2014. Métodos: As áreas de estudo englobaram as capitais da Região Sul do Brasil: Curitiba (PR), Florianópolis (SC) e Porto Alegre (RS), a população de estudo abrangeu os casos de DMI notificados entre 1991 a 2015 à vigilância da doença e residentes nessas capitais. A definição de caso adotada foi a padronizada pelo Ministério da Saúde. As fontes de dados foram: vigilância da DMI, o Instituto Adolfo Lutz, o Instituto Brasileiro de Geografia e Estatística e o Instituto de Pesquisa e Planejamento Urbano de Curitiba. A tendência da incidência e mortalidade da DMI foi determinada pelo modelo de regressão polinomial. A intensidade e a direção da relação linear entre a taxa de incidência e os indicadores socioeconômicos, de saúde e sorogrupo foram analisadas pelo coeficiente de correlação de Pearson. O impacto da VCMC foi estimado pela Fração Prevenida na População, comparando as taxas de incidência de 2012 e 2015 com as de 2009. Investigou-se os potenciais fatores associados a casos pertencentes a cluster no período de 2001 a 2014 por meio das estimativas de odds ratio não ajustada e ajustadas pela regressão logística múltipla não condicional, com os respectivos intervalos de confiança de 95%. Resultados: No período de estudo, a DMI apresentou três comportamentos distintos nas capitais da região sul: i) epidêmico na década de 1990, ii) declínio das taxas na década de 2000, antes da introdução da VCMC na rotina de imunização e, iii) estacionário com taxas baixas entre 2011 e 2015, sob a influência da VCMC. Observamos nesses períodos a influência de fatores biológicos, socioeconômicos e de saúde na incidência dessas capitais. No estudo mais detalhado em Curitiba, apresentou-se associado aos casos pertencentes a cluster, ajustados no tempo e pela idade, residir em bairros de baixa renda (OR: 2,3, IC95%:1,1-4,5). O sorogrupo predominante foi o B com 65,4%, seguida pelo C com 24,5% e 8,3% pelo W. Possivelmente, em virtude da baixa incidência do sorogrupo C, não se verificou a redução na incidência total da DMI, nestas capitais. Entretanto, no período posterior a VCMC, os casos pelo sorogrupo C foram raros ou zerados na faixa etária destinada a vacinação em Curitiba e Florianópolis. Em Porto Alegre foram registrados casos pelo sorogrupo C na faixa etária vacinada e o sorogrupo W se destacou. Conclusão: A partir do início desse século houve declínio expressivo da incidência da DMI nas capitais da região Sul do país, antes mesmo da introdução da vacina, aproximando-se das taxas de DMI encontradas em países de elevada renda. Tais resultados são consistentes, com trabalhos que mostram uma associação da DMI com as condições de vida e grau de desenvolvimento das populações

Objectives: To analyze the trend and describe changes in the epidemiology of invasive meningococcal disease (IMD) and to estimate the impact of the meningococcal conjugate C vaccine (MCCV) in the capitals of the southern region of Brazil, from 1991 to 2015, as well as to investigate the sociodemographic, economic and technological interventions associated to the cases belonging in cluster of the disease in the city of Curitiba (PR), from 2001 to 2014. Methods: The study areas included the capitals of the States of Southern Brazil: Curitiba (PR), Florianópolis (SC) and Porto Alegre (RS), the study population considered cases of IMD reported between 1991 and 2015 to surveillance and residents in these capitals. The IMD case definition adopted was that standardized by the Ministry of Health. The data sources were the surveillance of the IMD, the Adolfo Lutz Institute, the Brazilian Institute of Geography and Statistics and the Institute of Research and Urban Planning of Curitiba. The trend of IMD incidence and mortality was determined by the polynomial regression model. The intensity and direction of the linear relationship between the incidence rate and socioeconomic indicators, health and serogroup were analyzed by the Pearson correlation coefficient. The impact of the MCCV was estimated by the Prevented Fraction for the Population comparing the incidence rates of 2012 and 2015 with those of 2009. We investigated the potential factors associated with cases belonging in cluster between 2001 and 2014 by the unadjusted and adjusted odds ratio estimates by the multiple unconditional logistic regression, with the respectives confidence intervals of 95%. Results: Between 1991 and 2015, IMD presented three distinct periods in the capitals of the southern region: i) epidemic in the 1990s, ii) decline in rates from 2000 to 2010, before the introduction of MCCV in immunization routine and (iii) stationary at low rates in 2011 to 2015, under the influence of MCCV. In this period, we observed the influence of biological, socioeconomic and health factors on the incidence of these capitals. In more detailed study in Curitiba, it was associated with cases belonging in cluster, adjusted in time and by age, to live in low-income neighborhoods (OR: 2.3, 95% CI: 1.1-4.5). Serogroup B was predominant with 65,4%, followed by C with 24,5% and 8,3% by W. Possibly, due to the low incidence of serogroup C, there was no reduction in the total incidence of IMD in these capitals. However, *in the period after MCCV, serogroup C cases were rare or zero in the age group destinedfor vaccination in Curitiba and Florianópolis. In Porto Alegre, cases were registered by serogroup C in the vaccinated age group and serogroup W was relevant. Conclusion: From the beginning of this century there was a significant decline in the incidence of IMD in the capitals of the southern region of the country, even before the introduction of the vaccine, approaching IMD rates found in high income countries. These results are consistent, with studies showing an association of IMD with living conditions and the degree of population development

Investigação da infecção subclínica por Neisseria Meningitidis em populações indígenas no Amazonas / Investigation of subclinical infection by Neisseria meningitidis in indigenous populations in the Amazon

A doença meningocócica é causada por Neisseria meningitidis, a qual é uma bactéria de transmissão respiratória que coloniza a nasofaringe humana em cerca de 5-10% da população em geral, normalmente, de forma assintomática. O portador assintomático é o principal elemento na cadeia de transmissão e manutenção em natureza desta bactéria, mesmo durante períodos epidêmicos. Não existem estudos epidemiológicos sobre a infecção por N. meningitidis em populações indígenas no Brasil. Realizamos um estudo epidemiológico de campo do tipo transversal com o objetivo de investigar a infecção assintomática por N. meningitidis em três aldeias indígenas na região do Rio Madeira, no estado do Amazonas: mura (n = 260), Munduruku (n = 268) e mura-pirahã (n = 172).Nas três aldeias incluídas (de acordo com a proximidade e contato com pessoas de centros urbanos), foram examinados com swab da nasofaringe e entrevistados 210 (19% de perda), 268 (0,8% de perda) e 108 (37% de perda) indivíduos, respectivamente. A tipagem fenotípica e genética dos isolados de portadores foi realizada pela técnica de soroaglutinação e de multilocus sequence typing (MLST), respectivamente. O perfil de resistência aos antimicrobianos foi determinado pelo método de E-teste. Na Aldeia São Félix, etnia Mura (bastante contato), encontramos uma prevalência de portadores de N. meningitidis de 2,4% (5/210) e de Neisseria lactamica de 6% (12/210)

Na Aldeia Fronteira, etnia Munduruku (pouco contato), encontramos uma prevalência de portadores de N. meningitidis de 1,5% (4/268), enquanto na Aldeia Pirahã do Maicí etnia mura-pirahã (quase nenhum contato), encontramos uma prevalência de portadores de N. meningitidis de 1,9% (2/108). Registro de doença meningocócica, com evolução para óbito, foi reportado apenas na aldeia São Félix, em 2014, em uma criança que estudava na escola, mas não residia na aldeia. A infecção assintomática foi associada ao deslocamento para fora da aldeia ou ao contato íntimo com quem se desloca com frequência nas três aldeias visitadas. A caracterização fenotípica identificou o sorogrupo B em todas as amostras de N. meningitidis isoladas dos portadores. A genotipagem por MLST identificou dois novos tipos sequenciados (ST): ST-13111 (complexo clonal [cc] 1136) e ST-13110 (-). Uma única cepa foi identificada como ST-11406 (-). O ST-13111 (cc1136) foi identificado nas três aldeias incluídas neste estudo. Os portadores foram tratados com azitromicina em dose única: crianças e adultos

Todas as cepas foram sensíveis à penicilina, ampicilina, ceftriaxona e cloranfenicol, as quais são utilizadas no tratamento da doença invasiva, além de rifampicina, ciprofloxacina e azitromicina, as quais são utilizadas para o tratamento dos portadores. A investigação identificou uma prevalência de portadores de N. meningitidis semelhante àquela encontrada para indivíduos que não são contatos íntimos de casos de doença meningocócica. Apenas o deslocamento para fora da aldeia como estudar, trabalhar, viajar esteve associado ao estado de portador. A prevalência de N. lactamica, uma espécie não patogênica e comensal da nasofaringe humana, também foi semelhante ao que já foi descrito anteriormente. Os STs identificados são, geralmente, isolados da nasofaringe humana e, raramente, de doença invasiva, o que pode justificar a ausência de casos de doença nas aldeias investigadas. No entanto, ficou demonstrado a introdução e circulação de N. meningitidis nas aldeias indígenas investigadas e, consequentemente, a possibilidade de introdução de cepas hiperinvasivas, as quais podem causar doença invasiva de início abrupto rapidamente progressivo e potencialmente fatal. Assim, o uso de vacinas antimeningocócicas fica justificado como a melhor forma de controle da doença meningocócica nas populações de áreas remota. (AU)

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

Evaluation of the impact of serogroup C meningococcal disease vaccination program in Brazil and its regions: a population-based study, 2001-2013

BACKGROUND Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian National Immunisation Program in 2010 for children < 1 year of age. OBJECTIVES The study objective was to evaluate the impact of this vaccination strategy. METHODS An observational, mixed ecological and analytical study was conducted, based on time series panel data from surveillance records (2001-2013). FINDINGS A total of 37,538 of meningococcal disease cases were recorded during the study period. Of these, 19,997 were attributed to serogroup C. A decrease in meningococcal disease serogroup C (MDC) incidence among children aged < 1 year [65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI: 14.6-79.1%) were found in the three years following vaccination introduction. Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI: 51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast region. MAIN CONCLUSIONS Vaccination against MDC in Brazil had a positive impact on the population of children aged < 1 year, across all regions, and on the 1-4 year-old cohort. Nevertheless, in our view there is scope for improving the vaccination strategy adopted in Brazil.

Síndrome de waterhouse friderichsen secundario a meningoccocemia fulminante / Waterhouse friderichsen secondaria to fulminant meningococemia

Neisseria meningitidis (meningococo), es un diplococo Gram negativo específico del ser humano, único reservorio conocido hasta la fecha; se clasifica en 13 serogrupos en base a la composición química de polisacárido capsular, no obstante, la enfermedad epidémica es causada por los serogrupos A, B, C, Y y W-135. En el presente caso clínico el agente patógeno aislado corresponde a la especie Neisseria meningitidis serogrupo W-135, cuya cepa no había sido aislada en 21 años en nuestro país y dicha anatomía patológica reportó hemorragia intracapsular de ambas glándulas suprarrenales secundaria al shock séptico inducido por la endotoxina específica de este patógeno(AU)

Neisseria meningitidis (meningococcus) is a Gram negative diplococcus specific to human and the only reservoir known to date; it is classified into 13 serogroups according to the chemical composition of capsular polysaccharide, however, epidemic disease is caused by serogroups A, B, C, Y and W-135. In this case we report an isolated pathogen that corresponds to serogroup W-135,This strain had not been isolated in 21 years in our country and this pathology reported intracapsular bleeding from both secondary adrenal glands to septic shock induced endotoxin specified pathogen(AU)

Enfermedad meningocóccica invasora por serogrupo B en dos niños chilenos vacunados contra serogrupos ACWY / Meningococcal invasive disease caused by serogroup B in two Chilean children vaccinated against ACWY serogroups

Invasive meningococcal disease (IMD) by serogroup W has become predominant in Chile since 2012, prompting vaccination with conjugate ACWY. We reported two pediatric cases in patients already vaccinated, which evolved with IMD by serogroup B. This should remind us to keep the alertness with this pathology, despite the current vaccination system in Chile, emphasizing in improve our epidemiological case definition and its diagnosis.

La Enfermedad Meningocóccica Invasora (EMI) por serogrupo W ha llegado a ser predominante en Chile desde el 2012, motivando estrategias de inmunización con vacunas conjugadas contra los serogrupos ACWY. Presentamos dos casos pediátricos de pacientes vacunados contra meningococo ACWY que evolucionaron con EMI por serogrupo B, lo que debe recordarnos la alerta y sospecha de esta patología, inclusive con el esquema de vacunación actual chileno, poniendo énfasis en mejorar nuestra definición epidemiológica de caso sospechoso para optimizar su diagnóstico.

Comparison of PCR-based methods for the simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in clinical samples

Abstract Background Several in-house PCR-based assays have been described for the detection of bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae from clinical samples. PCR-based methods targeting different bacterial genes are frequently used by different laboratories worldwide, but no standard method has ever been established. The aim of our study was to compare different in-house and a commercial PCR-based tests for the detection of bacterial pathogens causing meningitis and invasive disease in humans. Methods A total of 110 isolates and 134 clinical samples (99 cerebrospinal fluid and 35 blood samples) collected from suspected cases of invasive disease were analyzed. Specific sets of primers frequently used for PCR-diagnosis of the three pathogens were used and compared with the results achieved using the multiplex approach described here. Several different gene targets were used for each microorganism, namely ctrA, crgA and nspA for N. meningitidis, ply for S. pneumoniae, P6 and bexA for H. influenzae. Results All used methods were fast, specific and sensitive, while some of the targets used for the in-house PCR assay detected lower concentrations of genomic DNA than the commercial method. An additional PCR reaction is described for the differentiation of capsulated and non-capsulated H. influenzae strains, the while commercial method only detects capsulated strains. Conclusions The in-house PCR methods here compared showed to be rapid, sensitive, highly specific, and cheaper than commercial methods. The in-house PCR methods could be easily adopted by public laboratories of developing countries for diagnostic purposes. The best results were achieved using primers targeting the genes nspA, ply, and P6 which were able to detect the lowest DNA concentrations for each specific target.

Cobertura da vacina meningocócica C nos estados e regiões do Brasil em 2012 / Coverage of the meningococcal C vaccine in the states and regions of Brazil in 2012 / Cobertura de la vacuna contra el meningococo C en los estados y regiones de Brasil en 2012

Objetivos: Descrever a cobertura da vacina meningocócica C em crianças menores de um ano de idade, em 2012, nos estados e regiões do Brasil, e correlacionar com variáveis socioeconômicas e cobertura da Estratégia de Saúde da Família. Métodos: Estudo ecológico. A cobertura vacinal foi calculada utilizando o número de doses da vacina em 2012, disponível no Sistema de Informação do Programa Nacional de Imunizações, como numerador, e população residente menor de um ano, também em 2012, como denominador. Ainda, foi realizada uma correlação de Pearson (r) entre a cobertura vacinal e as variáveis socioeconômicas. Resultados: As regiões Norte e Nordeste não atingiram a recomendação de 95% para cobertura. A cobertura vacinal apresentou correlação positiva moderada com renda média per capita (r=0,6) e negativa e moderada com o coeficiente de Gini (r=-0,5). Conclusão: São necessárias ações educativas e políticas para aumentar a cobertura vacinal com objetivo de reduzir a incidência da doença meningocócica, além de estudos com delineamentos mais robustos.

Objectives: To determine the coverage of the meningococcal C vaccine in children younger than one year of age in the states and regions of Brazil in 2012, and to correlate these findings with socioeconomic variables and the coverage of the Family Health Strategy. Methods: This was an ecological study. The vaccination coverage was calculated by dividing the number of vaccine doses administered in 2012 (numerator), which was determined from the data available in the Information System of the National Immunization Program, by the resident population less than one year also in 2012 (denominator). The Pearson correlation coefficient (r) was calculated for the vaccination coverage and socioeconomic variables. Results: The North and Northeast regions did not reach the recommended vaccination coverage (95%). The vaccination coverage showed a positive and moderate correlation with family income (r=0.6) and a negative and moderate correlation with the Gini coefficient (r=-0.5). Conclusion: Educational programs and policies are required to increase vaccination coverage and reduce the incidence of meningococcal disease. In addition, studies with more robust designs are necessary

Objetivos: Describir la cobertura de la vacuna contra el meningococo C en niños menores de un año de edad, en 2012, en los estados y regiones de Brasil, y correlacionar con variables socioeconómicas y cobertura de la Estrategia Salud de la Familia. Métodos: Estudio Ecológico. La cobertura de vacunación se calculó utilizando el número de dosis de la vacuna en 2012, disponible en el Sistema de Información del Programa Nacional de Inmunización, como numerador, y la población residente menor a un año, también en 2012, como denominador. Se realizó la correlación de Pearson (r) entre cobertura de la vacuna y las variables socioeconómicas. Resultados: En las regiones Norte y Noreste no alcanzaron la cobertura recomendada del 95%. La cobertura de vacunación mostró correlación positiva moderada con el ingreso promedio per cápita (r=0,6), y negativa moderada con el coeficiente de Gini (r=-0,5). Conclusión: Son necesarias acciones educativas e políticas para aumentar la cobertura de vacunación, con el fin de reducir la incidencia de la enfermedad meningocócica, así como los estudios con diseños más robustos.

Meningitis neonatal por Neisseria meningitidis serogrupo B / Neonatal meningitis caused by serogroup B Neisseria meningitides

La meningitis meningocóccica es una infección poco frecuente en el período neonatal internacionalmente, y solo hay una publicación previa en la literatura médica cubana hace 25 años atrás, de recién nacidos con meningitis bacteriana causada por Neisseria meningitidis. Se presenta el caso de un recién nacido febril, con manifestaciones de toxicidad, fontanela abombada, y cuando se realizó punción lumbar, se encontró pleocitosis del líquido cefalorraquídeo y se aisló N. meningitidis serogrupo B, por lo que se diagnostica meningitis meningocóccica neonatal. Tuvo evolución favorable. Se describen algunas características de la infección meningocócica, y se destaca el diagnóstico y tratamiento recomendado para este tipo de infección, así como se hace referencia a reportes de casos publicados en la literatura internacional.

Meningoccocal meningitis is a rare infection in the neonatal period worldwide and there is just one publication in the Cuban medical literature dated 25 years ago, which presented some neonates with bacterial meningitis caused by Neisseria meningitides. This is a febrile neonate with toxicity manifestations and bulging fontanelle; he was performed a lumbar puncture to find spinal fluid pleocytosis and the serogroup B N. meningitides was then isolated, so he was diagnosed with neonatal meningococcal meningitis with favorable progression. Some characteristics of the meningococcal infection, the diagnosis and recommended treatment were described in addition to making reference to case reports published in the international literature.

Lifetime cost of meningococcal disease in France: Scenarios of severe meningitis and septicemia with purpura fulminans

Invasive meningococcal disease [IMD] is life-threatening and can result in severe sequelae. In France, no data have been published on the costs of severe IMD cases. Two realistic scenarios were developed with national experts [clinicians and social workers]: a 6-year-old child with purpura fulminans with amputation of both legs below the knee [case A] and a 3-year-old with meningitis and severe neurological sequelae [case B]. Additional scenarios included other typical sequelae of IMD such as chronic kidney disease [CKD] profound deafness and epilepsy. Data on healthcare, disability, educational and other resource use were obtained from experts and families of patients with similar sequelae. Unit costs [2013] were mainly obtained from the literature and the National Health Insurance [NHI]. Time horizon was based on life expectancies of patients [77 and 55 years, respectively]. A 4% discount rate decreasing to 2% after 30 years was applied. Costs are presented from the perspective of the NHI, publicly funded organizations and patients' families or their private health insurances, purpura fulminans with amputations is associated with a lifelong discounted cost of €768,875. Adding CKD doubles the amount [€ 1,480,545]. Meningitis with severe neuro-cognitive sequelae results in a lifelong discounted cost of €1,924,475. Adding profound deafness and epilepsy slightly increases the total cost [€2,267,251]. The first year is the most expensive in both scenarios [€166,890 and €160,647 respectively]. The main cost drivers for each scenario are prostheses and child/adult stays in healthcare facilities, respectively. Overall, patients' families or his private insurance had to pay around 13% of total cost [101,833€ and 258,817€, respectively]. This study fills a gap in the body of knowledge on IMD sequelae care and lifetime costs in France. The potentially high economic burden of IMD, in addition to its physical, psychological and social burden, reinforces the need for prevention

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

Méningites à méningocoque en milieu pédiatrique sénégalais. A propos de 79 cas

La méningite cérébrospinale constitue un problème majeur de santé publique, du fait de son potentiel épidémique. Objectifs : L'objectif de ce travail était de décrire les caractéristiques cliniques, épidémiologiques, cliniques, bactériologiques et évolutives des méningites à méningocoque au Centre Hospitalier National d'Enfants Albert Royer (CHNEAR). Méthodes : Il s'agit d'une étude rétrospective, descriptive, et analytique. Tous les enfants âgés de 0 à 15 ans, hospitalisés pour méningite à méningocoque au CHNEAR, entre le 1er janvier 2004 et le 31 décembre 2013, étaient inclus dans cette étude. Résultats : Nous avons colligé 79 cas de méningite à méningocoque parmi les 1491 cas de méningites bactériennes pédiatriques (MBP). Ce qui représentait 3,45% des méningites bactériennes et 0,18% de l'ensemble des hospitalisations. Le sex-ratio 1,92 était en faveur des garçons. L'âge moyen était de 53,3 mois. La majorité des cas était survenue durant la saison sèche, soit 72%, avec des pics en mars et avril. La malnutrition a été décrite chez 4 enfants. La symptomatologie clinique était dominée par la fièvre (95%), la raideur méningée (82,3%), les céphalées (34,2%) et les troubles digestifs (34,2%). Le sérogroupe W135 (54 cas) était le plus isolé suivi des sérogroupes B (7 cas), C (7 cas), et A (5 cas). Dans 6 cas, le sérogroupe était indéterminé. La létalité était de 3,8%. Conclusion : L'incidence des méningites à méningocoques est de 0,18% en milieu pédiatrique sénégalais. Le sérogroupe W135 est en responsable de 2/3 des cas, d'où la nécessité de sa prise en compte dans les stratégies vaccinales actuelles au Sénégal

Caracterização fenotípica e genotípica de cepas invasivas de Neisseria meningitidis sorogrupo Y isoladas no Brasil durante o período de 2007 a 2011 / Phenotypic and genotypic characterization of invasive serogroup Y Neisseria meningitidis strains isolated in Brazil, 2007 and 2001

A Doença Meningocócica (DM) é de extrema importância para a Saúde Pública por sua tendência secular em causar surtos e epidemias, e pela alta letalidade e morbidade. Os sorogrupos A, B, C, W, Y e X de N. meningitidis são os responsáveis pela maioria dos casos de DM. Na última década observou-se, em cenário mundial, um crescente aumento no número de casos de DM pelo sorogrupo Y, e frequentemente associado ao complexo clonal ST-23/Cluster A3. Frente a este novo panorama epidemiológico da DM, o presente estudo teve como objetivo promover a caracterização fenotípica e genotípica das cepas de N. meningitidis sorogrupo Y isoladas no Brasil durante o período de 2007 a 2011. Das 68 cepas de N. meningitidis Y estudadas, isoladas de onze estados brasileiros, foram observados 20 genótipos diferentes para o gene porA, sendo o 18-1,3 o mais prevalente (22.1%), seguido pelo 5-1,2-2 (16.2%), 5-2,10-2 (14.7%) e 22,9 (7.4%). A maioria das amostras apresentou fHbp variante 2 (89.4%), seguido das variantes 3 (6.1%) e 1 (4.5%), e somente quatro (5.9%) cepas expressaram NadA. Um total de 21 STs foram determinados, sendo oito (36.4%) novos STs descritos neste estudo. As amostras foram agrupadas em sete diferentes complexos clonais, com a prevalência do complexo ST-23/Cluster A3 (25%), seguido do ST-175 (17.6%), ST-22 (7.4%), ST-174 (7.4%), ST-11 (3%), ST-167(3%), e ST-60 (3%). Os resultados demonstram, no Brasil, a circulação dos clones descritos como responsáveis pelo aumento do número de casos da DM pelo sorogrupo Y nos Estados Unidos e na Europa. Os dados reforçam a importância do monitoramento do sorogrupo Y na construção de novas estratégias de controle e prevenção da DM no país

Meningococcal disease (MD) is of great importance for public health for its tendency to cause outbreaks and epidemics, and for the high letality and morbidity. Serogroups A, B, C, W, Y and X of N. meningitidis are responsible for most of the MD cases. In the last decade, the increasing number of MD cases associated with serogroup Y, and often associated with the ST-23/Cluster A3 clonal complex has been observed worldwide. Facing this new epidemiological landscape of MD, the present study was aimed to characterize the phenotypically and genotypicaly of strains of N. meningitidis serogroup Y isolated in Brazil between 2007 and 2011. Among of 68 strains of N. meningitidis Y isolates from eleven Brazilian states, 20 different genotypes were observed for porA gene, 18-1,3 being the most prevalent (22.1%), followed by 5-1,2-2 (16.2% ), 5-2,10-2 (14.7%) and 22,9 (7.4%). Most of isolates showed fHbp variant 2 (89.4%), followed by variant 3 (6.1%) and 1 (4.5%), and only four (5.9%) strains expressed NadA. A total of 21 STs were determined, including eight (36.4%) new STs described in this study. The isolates were grouped into seven different clonal complexes, with the prevalence of the ST-23/Cluster A3 complex (25%), followed by ST-175 (17.6%), ST-22 (7.4%), ST-174 (7.4%), ST-11 (3%), 167 (3%), and ST-60 (3%). The results show, in Brazil, the circulation of the clones described as increasing the number of MD cases associated with serogroup Y in the United States and Europe. The data reinforce the importance of serogroup Y monitoring in the construction of new control strategies and prevention of DM in Brazil