1887

Abstract

The laboratory confirmation of meningococcal disease and characterization of isolates was improved considerably in England and Wales by the Meningococcal Reference Unit between epidemiological years 1993/94 and 2003/04 to meet the challenge of increasing numbers of cases of clinical disease and the requirement for enhanced surveillance. Improved case ascertainment was made possible by the rapid introduction of an innovative centralized reference service for non-culture PCR-based DNA detection of meningococci utilizing the and PCR assays, complemented by consistent phenotypic characterization of submitted isolates from culture-proven cases. This allowed the increased prevalence of serogroup C disease in specific age groups and the apparent associated increase in mortality from 1995/96 to 1999/00 to be defined, thereby prompting accelerated intervention with the newly licensed meningococcal serogroup C conjugate (MCC) vaccines into the under-25-year UK population (in November 1999). The continued increase in and predominance of serogroup B cases (1993/94 to 2000/01) were observed in conjunction with their diverse and changing phenotypic characteristics. Trends observed to be associated with the predominant phenotypic combinations of serogroup, serotype and sero-subtype were: a decline of both C : 2b and B : 2b meningococci, and a decline of B : 15 : P1.7,16 with a concomitant increase of B : 4 : P1.4 over the 11-year period. Detailed routine surveillance rapidly confirmed the introduction of W135 : 2a : P1.5,2 meningococci into the UK during 2000 and 2001. The importance of continued detailed surveillance of this important pathogen cannot be overestimated, both to monitor the effectiveness of the MCC vaccine and to identify changes within the meningococcal population that can inform the design of anti-serogroup B vaccines.

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2006-07-01
2019-10-24
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References

  1. Bohr, V., Rasmussen, N., Hansen, B., Kjersem, H., Jessen, O., Johnsen, N. & Kristensen, H. S. ( 1983; ). 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series. J Infect 7, 193–202.[CrossRef]
    [Google Scholar]
  2. Booy, R., Habibi, P., Nadel, S., de Munter, C., Britto, J., Morrison, A., Levin, M. & Meningococcal Research Group ( 2001; ). Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child 85, 386–390.[CrossRef]
    [Google Scholar]
  3. Borrow, R., Claus, H., Guiver, M., Smart, L., Jones, D. M., Kaczmarski, E. B., Frosch, M. & Fox, A. J. ( 1997; ). Non-culture diagnosis and serogroup determination of meningococcal B and C infection by sialyltransferase (siaD) PCR ELISA. Epidemiol Infect 118, 1111–1123.
    [Google Scholar]
  4. Borrow, R., Claus, H., Chaudhry, U., Guiver, M., Kaczmarski, E. B., Frosch, M. & Fox, A. J. ( 1998; ). SiaD PCR ELISA for the confirmation and identification of serogroup Y and W135 meningococcal infections. FEMS Microbiol Lett 159, 209–214.[CrossRef]
    [Google Scholar]
  5. Cartwright, K., Reilly, S., White, D. & Stuart, J. ( 1992; ). Early treatment with parenteral penicillin in meningococcal disease. BMJ 305, 143–147.[CrossRef]
    [Google Scholar]
  6. Caugant, D. A., Zollinger, W. D., Mocca, L. F., Frasch, C. E., Whittam, T. S., Frøholm, L. O. & Selander, R. K. ( 1987; ). Genetic relationships and clonal population structure of serotype 2 strains of Neisseria meningitidis. Infect Immun 55, 1503–1512.
    [Google Scholar]
  7. Chief Medical Officer, Chief Nursing Officer, and the Chief Pharmacist ( 1999; ). Start of the New Meningococcal C Conjugate Vaccine Immunisation Programme. London, UK: Department of Health. http://www.dh.gov.uk/assetRoot/04/06/52/11/04065211.pdf
  8. Chief Medical Officer, the Chief Nursing Officer, and the Chief Pharmacist ( 2002; ). Extending Meningitis C Vaccine to 20–24 Year Olds; Pneumococcal Vaccine for at-Risk under 2 Year Olds. London, UK: Department of Health. http://www.dh.gov.uk/assetRoot/04/01/34/85/04013485.pdf
  9. Davison, E., Borrow, R., Guiver, M., Kaczmarski, E. B. & Fox, A. J. ( 1996; ). The adaptation of the IS1106 PCR to a PCR ELISA format for the diagnosis of meningococcal infection. Serodiagn Immunother Infect Dis 8, 51–56.[CrossRef]
    [Google Scholar]
  10. Diggle, M. A., Smith, K., Girvan, E. K. & Clarke, S. C. ( 2003; ). Evaluation of a fluorescence-based PCR method for identification of serogroup A meningococci. J Clin Microbiol 41, 1766–1768.[CrossRef]
    [Google Scholar]
  11. Guiver, M. & Borrow, R. ( 2001; ). PCR diagnosis. In Meningococcal Disease: Methods and Protocols, pp. 23–39. Edited by A. J. Pollard & M. C. J. Maiden. Totowa, NJ: Humana Press.
  12. Guiver, M., Borrow, R., Marsh, J., Gray, S. J., Kaczmarski, E. B., Howells, D., Bosely, P. & Fox, A. J. ( 2002; ). Evaluation of the Applied Biosystems automated TaqMan PCR system for the detection of meningococcal DNA. FEMS Immunol Med Microbiol 28, 173–179.
    [Google Scholar]
  13. Hahne, S. J., Gray, S. J., Jean-Francois, A., Crowcroft, N. S., Nichols, T., Kaczmarski, E. B. & Ramsay, M. E. ( 2002a; ). W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001. Lancet 359, 582–583.[CrossRef]
    [Google Scholar]
  14. Hahne, S. J., Handford, S. & Ramsay, M. E. ( 2002b; ). W135 meningococcal carriage in Hajj pilgrims. Lancet 360, 2089–2090. Erratum in Lancet 361, 882.
    [Google Scholar]
  15. Kaczmarski, E. B., Ragunathan, P. L., Marsh, J., Gray, S. J. & Guiver, M. ( 1998; ). Creating a national service for the diagnosis of meningococcal disease by polymerase chain reaction. Commun Dis Public Health 1, 54–56.
    [Google Scholar]
  16. Kuipers, B., van den Dopplesteen, G., Wedege, E. & van Alphen, L. ( 2001; ). Serological characterization. In Meningococcal Disease: Methods and Protocols, pp. 131–145. Edited by A. J. Pollard & M. C. J. Maiden. Totowa, NJ: Humana Press.
  17. Maiden, M. C., Bygraves, J. A., Feil, E. & 10 other authors ( 1998; ). Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms. Proc Natl Acad Sci U S A 95, 3140–3145.[CrossRef]
    [Google Scholar]
  18. Maiden, M. C. J., Stuart, J. M., on behalf of the UK Meningococcal Carriage Group ( 2002; ). Carriage of serogroup C meningococci one year after meningococcal C conjugate polysaccharide vaccination. Lancet 359, 1829–1830.[CrossRef]
    [Google Scholar]
  19. Miller, E., Salisbury, D. M. & Ramsay, M. E. ( 2001; ). Planning, registration, and implementation of an immunisation campaign against meningococcal serogroup C disease in the UK: a success story. Vaccine 20, S58–S67.[CrossRef]
    [Google Scholar]
  20. Ni, H., Knight, A. I., Cartwright, K. A. V., Palmer, W. H. & McFadden, J. ( 1992; ). Polymerase chain reaction for the diagnosis of meningococcal meningitis. Lancet 340, 1432–1434.[CrossRef]
    [Google Scholar]
  21. Overlid, P., Backman, A. & Olcen, P. ( 1999; ). PCR identification of the group A Neisseria meningitidis gene in cerebrospinal fluid. Scand J Infect Dis 31, 481–483.[CrossRef]
    [Google Scholar]
  22. Ramsay, M., Kaczmarski, E., Rush, M., Mallard, R., Farrington, P. & White, J. ( 1997; ). Changing patterns of case ascertainment and trends in meningococcal disease in England and Wales. Commun Dis Rep CDR Rev 7, 49–54.
    [Google Scholar]
  23. Ramsay, M. E., Andrews, N., Kaczmarksi, E. B. & Miller, E. ( 2001; ). Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet 357, 195–196.[CrossRef]
    [Google Scholar]
  24. Ramsay, M. E., Andrews, N. J., Trotter, C. L., Kaczmarski, E. B. & Miller, E. ( 2003; ). Herd immunity from meningococcal serogroup C conjugate vaccination in England. BMJ 326, 365–366.[CrossRef]
    [Google Scholar]
  25. Richards, P. G. & Towu-Aghantse, E. ( 1986; ). Dangers of lumbar puncture. BMJ 292, 605–606.[CrossRef]
    [Google Scholar]
  26. Rosenqvist, E., Wedege, E., Hoiby, E. A. & Froholm, L. O. ( 1990; ). Serogroup determination of Neisseria meningitidis by whole-cell ELISA, dot-blotting and agglutination. APMIS 98, 501–506.[CrossRef]
    [Google Scholar]
  27. Thorburn, K., Baines, P., Thomson, A. & Hart, C. A. ( 2001; ). Mortality in severe meningococcal disease. Arch Dis Child 85, 382–385.[CrossRef]
    [Google Scholar]
  28. Trotter, C. L., Fox, A. J., Ramsay, M. E., Sadler, F., Gray, S. J., Mallard, R. & Kaczmarski, E. B. ( 2002a; ). Fatal outcome from meningococcal disease – an association with meningococcal phenotype but not with reduced susceptibility to benzylpenicillin. J Med Microbiol 51, 855–860.
    [Google Scholar]
  29. Trotter, C. L., Ramsay, M. E. & Kaczmarski, E. B. ( 2002b; ). Meningococcal serogroup C vaccination in England and Wales: coverage and initial impact of the campaign. Commun Dis Public Health 5, 220–225.
    [Google Scholar]
  30. Trotter, C. L., Andrews, N. J., Kaczmarski, E. B., Miller, E. & Ramsay, M. E. ( 2004; ). Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 364, 365–367.[CrossRef]
    [Google Scholar]
  31. Urwin, R., Feavers, I. M., Jones, D. M., Maiden, M. C. & Fox, A. J. ( 1998; ). Molecular variation of meningococcal serotype 4 antigen genes. Epidemiol Infect 121, 95–101.[CrossRef]
    [Google Scholar]
  32. Wedege, E., Hoiby, E. A., Rosenqvist, E. & Froholm, L. O. ( 1990; ). Serotyping and serosubtyping of Neisseria meningitidis isolates by co-agglutination, dot-blotting and ELISA. J Med Microbiol 31, 195–201.[CrossRef]
    [Google Scholar]
  33. Wedege, E., Kolberg, J., Delvig, A., Høiby, E. A., Holten, E., Rosenqvist, E. & Caugant, D. A. ( 1995; ). Emergence of a new virulent clone within the electrophoretic type 5 complex of serogroup B meningococci in Norway. Clin Diagn Lab Immunol 2, 314–321.
    [Google Scholar]
  34. Whalen, C. M., Hockin, J. C., Ryan, A. & Ashton, F. ( 1995; ). The changing epidemiology of invasive meningococcal disease in Canada, 1985 through 1992. Emergence of a virulent clone of Neisseria meningitidis. JAMA (J Am Med Assoc) 273, 390–394.[CrossRef]
    [Google Scholar]
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