An expanded age range for meningococcal meningitis: molecular diagnostic evidence from population-based surveillance in Asia

BMC Infectious Diseases

Paul E Kilgore⁶  Dang Duc Anh¹  Jung Soo Kim²  Bai Qing Dong⁴  Dong Wook Kim³  Soon Ae Kim⁵ 

[1] National Institute of Hygiene and Epidemiology, Hanoi, Vietnam;Department of Pediatrics, Jeonbuk National University Hospital, Jeonju, South Korea;Laboratory Science Division, International Vaccine Institute, Seoul, South Korea;Guangxi Zhuang Autonomous Region Center for Disease Control & Prevention, Nanning, China;Translational Research Division, International Vaccine Institute, SNU Research Park, San 4-8 Nakseongdae-Dong, Kwanak Gu, Seoul, 151-919, South Korea;Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, USA

关键词: Surveillance;    Serogroup;    Neisseria meningitidis;    Meningococcal meningitis;    Cerebrospinal fluid;   

Others  :  1175142
DOI  :  10.1186/1471-2334-12-310

 received in 2012-05-29, accepted in 2012-11-05,  发布年份 2012

【 摘 要 】

Background

To understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam.

Methods

A total of 295 isolates and 2,302 CSFs were tested by a meningococcal species- and serogroup-specific polymerase chain reaction (PCR) assay targeting the Neisseria meningitidis (Nm) ctrA gene. Multi-locus sequence typing (MLST) was performed in Nm gene amplification analysis and incidence rates for meningococcal meningitis were estimated.

Results

Among 295 isolates tested, 10 specimens from Vietnam were confirmed as serogroup B and all were Sequence Type (ST) 1576 by MLST. Among the 2,032 CSF specimen tested, 284 (14%) were confirmed by PCR (ctrA gene), including 67 (23.6%) from China, 92 (32.4%) from Korea, and 125 (44.0%) from Vietnam. Neonates and infants aged < 6 months of age accounted for more than 50% of Nm-PCR positive CSF. Two CSF specimens from Vietnam were identified as serogroup B using MLST. In addition, 44 specimens underwent sequencing to confirm meningococcal serogroup; of these, 21 (48%) were serogroup C, 12 (27%) were serogroup X, 9 (20%) were serogroup Y and 2 (5%) were serogroup B. The incidence rates of meningococcal meningitis among children < 5 years of age was highest in Vietnam (7.4/100,000 [95% CI, 3.6—15.3] followed by Korea (6.8/100,000 [95% CI, 3.5-13.5] and China (2.1/100,000) [95% CI, 0.7-6.2]).

Conclusions

These results suggest that there is a previously undetected, yet substantial burden of meningococcal meningitis among infants and young children. Standardized, sensitive and specific molecular diagnostic assays with Nm serogrouping capacity are needed throughout Asia to understand the true burden of N. meningitidis disease.

【 授权许可】

   
2012 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Van Deuren M, Meis JF: Meningococcal disease. N Engl J Med 2001, 345(9):699.
• [2]Stephens DS, Greenwood B, Brandtzaeg P: Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007, 369(9580):2196-2210.
• [3]Tan LK, Carlone GM, Borrow R: Advances in the development of vaccines against Neisseria meningitidis. N Engl J Med 2010, 362(16):1511-1520.
• [4]Trotter CL, Greenwood BM: Meningococcal carriage in the African meningitis belt. Lancet Infect Dis 2007, 7(12):797-803.
• [5]Chanteau S, Rose AM, Djibo S, Nato F, Boisier P: Biological diagnosis of meningococcal meningitis in the African meningitis belt: current epidemic strategy and new perspectives. Vaccine 2007, 25(Suppl 1):A30-A36.
• [6]Boisier P, Mainassara HB, Sidikou F, Djibo S, Kairo KK, Chanteau S: Case-fatality ratio of bacterial meningitis in the African meningitis belt: we can do better. Vaccine 2007, 25(Suppl 1):A24-A29.
• [7]Hayward P: African meningitis belt: 2006. Lancet Neurol 2006, 5(5):389.
• [8]Wilder-Smith A: W135 meningococcal carriage in association with the Hajj pilgrimage 2001: the Singapore experience. Int J Antimicrob Agents 2003, 21(2):112-115.
• [9]Meningococcal infection in pilgrims returning from the Haj: update Commun Dis Rep CDR Wkly 2000, 10(17):149-152.
• [10]Meningococcal disease associated with the Haj-update Commun Dis Rep CDR Wkly 2000, 10(19):169.
• [11]Galloway Y, Stehr-Green P, McNicholas A, O’Hallahan J: Use of an observational cohort study to estimate the effectiveness of the New Zealand group B meningococcal vaccine in children aged under 5 years. Int J Epidemiol 2009, 38(2):413-418.
• [12]Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, McIntyre P, Ramsay ME, Safadi MA: The changing and dynamic epidemiology of meningococcal disease. Vaccine 2012, 30(Suppl 2):B26-B36.
• [13]Vyse A, Wolter JM, Chen J, Ng T, Soriano-Gabarro M: Meningococcal disease in Asia: an under-recognized public health burden. Epidemiol Infect 2011, 139:967-985.
• [14]Lee SO, Ryu SH, Park SJ, Ryu J, Woo JH, Kim YS: Meningococcal disease in the republic of Korea army: incidence and serogroups determined by PCR. J Korean Med Sci 2003, 18(2):163-166.
• [15]Raja NS, Parasakthi N, Puthucheary SD, Kamarulzaman A: Invasive meningococcal disease in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. J Postgrad Med 2006, 52(1):23-29.
• [16]Robbins JB, Schneerson R, Gotschlich EC, Mohammed I, Nasidi A, Chippaux JP, Bernardino L, Maiga MA: Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines. Bull World Health Organ 2003, 81(10):745-750.
• [17]Choudhuri D, Huda T, Theodoratou E, Nair H, Zgaga L, Falconer R, Luksic I, Johnson HL, Zhang JS, El Arifeen S, et al.: An evaluation of emerging vaccines for childhood meningococcal disease. BMC Publ Health 2011, 11(Suppl 3):S29. BioMed Central Full Text
• [18]Harrison LH, Trotter CL, Ramsay ME: Global epidemiology of meningococcal disease. Vaccine 2009, 27(Suppl 2):B51-B63.
• [19]Anh DD, Kilgore PE, Slack MP, Nyambat B, le Tho H, Yoshida LM, Nguyen HA, Nguyen CD, Chong CY, Nguyen D, et al.: Surveillance of pneumococcal-associated disease among hospitalized children in Khanh Hoa Province, Vietnam. Clin Infect Dis 2009, 48(Suppl 2):S57-S64.
• [20]Anh DD, Kilgore PE, Kennedy WA, Nyambat B, Long HT, Jodar L, Clemens JD, Ward JI: Haemophilus influenzae type B meningitis among children in Hanoi, Vietnam: epidemiologic patterns and estimates of H. Influenzae type B disease burden. AmJTrop Med Hyg 2006, 74(3):509-515.
• [21]Kim JS, Jang YT, Kim JD, Park TH, Park JM, Kilgore PE, Kennedy WA, Park E, Nyambat B, Kim DR, et al.: Incidence of Haemophilus influenzae type b and other invasive diseases in South Korean children. Vaccine 2004, 22(29–30):3952-3962.
• [22]Taha MK, Alonso JM, Cafferkey M, Caugant DA, Clarke SC, Diggle MA, Fox A, Frosch M, Gray SJ, Guiver M, et al.: Interlaboratory comparison of PCR-based identification and genogrouping of Neisseria meningitidis. J Clin Microbiol 2005, 43(1):144-149.
• [23]Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB: Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 2001, 39(4):1553-1558.
• [24]Llull D, Lopez R, Garcia E: Characteristic signatures of the lytA gene provide a basis for rapid and reliable diagnosis of Streptococcus pneumoniae infections. J Clin Microbiol 2006, 44(4):1250-1256.
• [25]Wilson K: Preparation of genomic DNA from bacteria. Curr Protoc Mol Biol 2001. Chapter 2:Unit 2. 4
• [26]Fraisier C, Stor R, Tenebray B, Sanson Y, Nicolas P: Use of a new single multiplex PCR-based assay for direct simultaneous characterization of six Neisseria meningitidis serogroups. J Clin Microbiol 2009, 47(8):2662-2666.
• [27]Newcombe RG: Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998, 17(8):873-890.
• [28]Disease trends: decrease in meningococcal group C http://www.meningitisuk.org/meningitis/disease/surveillance/disease-trends.htm webcite.
• [29]Cohn AC, MacNeil JR, Harrison LH, Hatcher C, Theodore J, Schmidt M, Pondo T, Arnold KE, Baumbach J, Bennett N, et al.: Changes in Neisseria meningitidis disease epidemiology in the United States, 1998–2007: implications for prevention of meningococcal disease. Clin Infect Dis 2009, 50(2):184-191.
• [30]Luca V, Gessner BD, Luca C, Turcu T, Rugina S, Rugina C, Ilie M, Novakova E, Vlasich C: Incidence and etiological agents of bacterial meningitis among children < 5 years of age in two districts of Romania. Eur J Clin Microbiol Infect Dis 2004, 23(7):523-528.
• [31]Hye Kyung Cho HL, Jin Han K, Kwang Nam K, Dong Soo K, Yun Kyung K, Jung Soo K, Jong-Hyun K, Chang Hwi K, Hwang Min K, Su-Eun P, Sung Hee O, Eun Hee C, Sung Ho C, Young Youn C, Jae Kyun H, Young Jin H, Hoan Jong L, Kyung-Hyo K: The causative organisms of bacterial meningitis in Korean Children in 1996–2005. J Korean Med Sci 2010, 25:895-899.
• [32]Oberti J, Hoi NT, Caravano R, Tan CM, Roux J: An epidemic of meningococcal infection in Vietnam (southern provinces). Bull World Health Organ 1981, 59(4):585-590.
• [33]Stein-Zamir C, Abramson N, Zentner G, Shoob H, Valinsky L, Block C: Invasive meningococcal disease in children in Jerusalem. Epidemiol Infect 2008, 136(6):782-789.
• [34]Dyet KH, Martin DR: Clonal analysis of the serogroup B meningococci causing New Zealand’s epidemic. Epidemiol Infect 2006, 134(2):377-383.
• [35]Tondella ML, Popovic T, Rosenstein NE, Lake DB, Carlone GM, Mayer LW, Perkins BA, The Active Bacterial Core Surveillance Team: Distribution of Neisseria meningitidis serogroup B serosubtypes and serotypes circulating in the United States. J Clin Microbiol 2000, 38(9):3323-3328.
• [36]Gessner BD, Sutanto A, Linehan M, Djelantik IG, Fletcher T, Gerudug IK, Ingerani , Mercer D, Moniaga V, Moulton LH, et al.: Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 2005, 365(9453):43-52.
• [37]Yang L, Shao Z, Zhang X, Xu L, Peng J, Xu X, Liang X, Qi Y, Jin Q: Genotypic characterization of Neisseria meningitidis serogroup B strains circulating in China. J Infect 2008, 56(3):211-218.
• [38]Zhang X, Shao Z, Yang E, Xu L, Xu X, Li M, Ren J, Zhu Y, Yang F, Liang X, et al.: Molecular characterization of serogroup C Neisseria meningitidis isolated in China. J Med Microbiol 2007, 56(Pt 9):1224-1229.
• [39]Xu Li SZ-j, Gao Y: Surveillance on pathogens of meningococcal meningitis in China, 2004-2006. Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206. Chin J Vaccines Immunization 2007., 3
• [40]Bae SM, Kang YH: Serological and genetic characterization of meningococcal isolates in Korea. Jpn J Infect Dis 2008, 61(6):434-437.
• [41]Snape MD, Medini D, Halperin SA, DeTora L, Drori J, Moxon ER: The challenge of post-implementation surveillance for novel meningococcal vaccines. Vaccine 2012, 30(Suppl 2):B67-B72.
• [42]Falcao MC, Andrade SB, Ceccon ME, Costa Vaz FA: Neonatal sepsis and meningitis caused by Neisseria meningitidis: a case report. Rev Inst Med Trop Sao Paulo 2007, 49(3):191-194.
• [43]Tinsa F, Jallouli M, Ben Lassouad M, Smaoui H, Brini I, Bousseta K, Bousnina S: Neonatal meningitis by Neisseria meningitidis B. Tunis Med 2008, 86(11):1014-1015.