1887

Abstract

Introduction:

serogroup B is an important infectious agent in developed countries, including Canada. Infants are particularly susceptible to infection with serogroup B because of immature immune systems, pathogen virulence factors and changing serogroup dynamics in the post-vaccination era. Currently, the Ontario provincial government does not include serogroup B in its routine publicly funded meningococcal vaccination program.

Case Presentation:

A formerly well 14-month-old male presented to a tertiary hospital emergency department with fever, minor respiratory problems, diffuse purpuric rash, distended abdomen, tachycardia, and history of one episode of vomiting and melena each. Meningococcaemia was immediately suspected, and he was treated with ceftriaxone, cefotaxime and vancomycin before transfer to a different acute care facility within 12 h. serogroup B, sensitive to ceftriaxone and penicillin, was identified in his blood. The patient developed gangrene of the lower legs and underwent bilateral below-knee amputation 8 days post-admission.

Conclusion:

This instance of meningococcaemia with extensive sequelae is an example of the various serious outcomes of meningococcal infection. It provides persuasive reason for routine publicly funded vaccination against serogroup B in Ontario.

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2016-02-05
2020-03-31
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References

  1. Adelson N.. 2005; The embodiment of inequity: health disparities in aboriginal Canada. Can J Public Health96:Suppl 2S45–S61
    [Google Scholar]
  2. Aghamohammadi A., Cheraghi T., Gharagozlou M., Movahedi M., Rezaei N., Yeganeh M., Parvaneh N., Abolhassani H., Pourpak Z., Moin M.. 2009; IgA deficiency: correlation between clinical and immunological phenotypes. J Clin Immunol29:130–136 [CrossRef][PubMed]
    [Google Scholar]
  3. Ammann A. J., Hong R.. 1971; Selective IgA deficiency: presentation of 30 cases and a review of the literature. Medicine (Baltimore)50:223–236 [CrossRef][PubMed]
    [Google Scholar]
  4. Andersen B. M.. 1989; Endotoxin release from neisseria meningitidis. Relationship between key bacterial characteristics and meningococcal disease. Scand J Infect Dis Suppl21:Suppl 641–43 [CrossRef][PubMed]
    [Google Scholar]
  5. Andrews S. M., Pollard A. J.. 2014; A vaccine against serogroup B Neisseria meningitidis: dealing with uncertainty. Lancet Infect Dis14:426–434 [CrossRef][PubMed]
    [Google Scholar]
  6. Bettinger J. A., Scheifele D. W., Le Saux N., Halperin S. A., Vaudry W., Tsang R., Canadian Immunization Monitoring Program, Active (IMPACT). 2009; The impact of childhood meningococcal serogroup C conjugate vaccine programs in Canada. Pediatr Infect Dis J28:220–224 [CrossRef][PubMed]
    [Google Scholar]
  7. Bettinger J. A., Scheifele D. W., Le Saux N., Halperin S. A., Vaudry W., Tsang R..Members of Canadian Immunization Monitoring Program, Active (IMPACT) 2013; The disease burden of invasive meningococcal serogroup B disease in Canada. Pediatr Infect Dis J32:e20–e25 [CrossRef][PubMed]
    [Google Scholar]
  8. Canavese F., Krajbich J. I., LaFleur B. J.. 2010; Orthopaedic sequelae of childhood meningococcemia: management considerations and outcome. J Bone Joint Surg Am92:2196–2203 [CrossRef][PubMed]
    [Google Scholar]
  9. Carter N. J.. 2013; Multicomponent meningococcal serogroup B vaccine (4CMenB; Bexsero®): a review of its use in primary and booster vaccination. BioDrugs27:263–274 [CrossRef][PubMed]
    [Google Scholar]
  10. Crowcroft N. S., Deeks S. L., Upshur R. E.. 2015; Do we need a new approach to making vaccine recommendations?. BMJ350:h308–h314 [CrossRef][PubMed]
    [Google Scholar]
  11. Dang V., Jamieson F. B., Wilson S., Rawte P., Crowcroft N. S., Johnson K., Tsang R. S., Deeks S. L.. 2012; Epidemiology of serogroup B invasive meningococcal disease in Ontario, Canada, 2000 to 2010. BMC Infect Dis12:202 [CrossRef][PubMed]
    [Google Scholar]
  12. Dashefsky B., Teele D. W., Klein J. O.. 1983; Unsuspected meningococcemia. J Pediatr102:69–72 [CrossRef][PubMed]
    [Google Scholar]
  13. Emonts M., Hazelzet J. A., de Groot R., Hermans P. W.. 2003; Host genetic determinants of Neisseria meningitidis infections. Lancet Infect Dis3:565–577 [CrossRef][PubMed]
    [Google Scholar]
  14. Galloway Y., Stehr-Green P., McNicholas A., O'Hallahan J.. 2009; 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 Epidemiol38:413–418 [CrossRef][PubMed]
    [Google Scholar]
  15. Giuliani M. M., Adu-Bobie J., Comanducci M., Aricò B., Savino S., Santini L., Brunelli B., Bambini S., Biolchi A.. 2006; A universal vaccine for serogroup B meningococcus. Proc Natl Acad Sci U S A103:10834–10839 [CrossRef][PubMed]
    [Google Scholar]
  16. Gounder P. P., Zulz T., Desai S., Stenz F., Rudolph K., Tsang R., Tyrrell G. J., Bruce M. G.. 2015; Epidemiology of bacterial meningitis in the North American Arctic, 2000-2010. J Infect71:179–187 [CrossRef][PubMed]
    [Google Scholar]
  17. Jacobsen S. T., Crawford A. H.. 1984; Amputation following meningococcemia. A sequela to purpura fulminans. Clin Orthop Relat Res185214–219
    [Google Scholar]
  18. Joint Committee on Vaccination and Immunisation 2014; JCVI position statement on use of Bexsero® meningococcal B vaccine in the UK.. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/294245/JCVI_Staement_on_MenB.pdf
  19. Khatami A., Pollard A. J.. 2010; The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines9:285–298 [CrossRef][PubMed]
    [Google Scholar]
  20. Kinlin L. M., Spain C. V., Ng V., Johnson C. C., White A. N. J., Fisman D. N.. 2009; Environmental exposures and invasive meningococcal disease: an evaluation of effects on varying time scales. Am J Epidemiol169:588–595 [CrossRef][PubMed]
    [Google Scholar]
  21. Law D. K. S., Lefebvre B., Gilca R., Deng S., Zhou J., De Wals P., Tsang R. S.. 2015; Characterization of invasive Neisseria meningitidis strains from Québec, Canada, during a period of increased serogroup B disease, 2009–2013: phenotyping and genotyping with special emphasis on the non-carbohydrate protein vaccine targets. BMC Microbiol15:143 [CrossRef][PubMed]
    [Google Scholar]
  22. Lee C. C., Middaugh N. A., Howie S. R., Ezzati M.. 2010; Association of secondhand smoke exposure with paediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLOS Med7:e1000374 [CrossRef]
    [Google Scholar]
  23. Le Saux N., Bettinger J. A., Wootton S., Halperin S. A., Vaudry W., Scheifele D. W., Tsang R.. 2009; Profile of serogroup Y meningococcal infections in Canada: implications for vaccine selection. Can J Infect Dis Med Microbiol20:e130–e134
    [Google Scholar]
  24. Levi M., de Jonge E., van der Poll T., ten Cate H.. 1999; Disseminated intravascular coagulation. Thromb Haemost82:695–705
    [Google Scholar]
  25. MacNeil J., Cohn A.. 2011; Meningococcal disease. In VPD Surveillance Manual, 5th edn.1–11Edited by Roush S. W., Baldy L. M.. Atlanta, GA: Centers for Disease Control and Prevention;
    [Google Scholar]
  26. Masignani V., Comanducci M., Giuliani M. M., Bambini S., Adu-Bobie J., Arico B., Brunelli B., Pieri A., Santini L.. 2003; Vaccination against Neisseria meningitidis using three variants of the lipoprotein GNA1870. J Exp Med197:789–799 [CrossRef][PubMed]
    [Google Scholar]
  27. National Advisory Committee on Immunization 2014; Advice for the use of multicomponent meningococcal serogroup B (4CMenB) vaccine.. http://publications.gc.ca/pub?id = 9.699195&sl = 0
  28. Neal K. R., Nguyen-Van-Tam J. S., Jeffrey N., Slack R. C. B., Madeley R. J., Ait-Tahar K., Job K., Wale M. C., Ala'Aldeen D. A.. 2000; Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study. BMJ320:846–849 [CrossRef][PubMed]
    [Google Scholar]
  29. Ontario Ministry of Health and Long-Term Care 2015; Immunization.. http://www.health.gov.on.ca/en/pro/programs/immunization/docs/immunization_schedule.pdf
  30. Ozkan H., Atlihan F., Genel F., Targan S., Gunvar T.. 2005; IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage. J Investig Allergol Clin Immunol15:69–74
    [Google Scholar]
  31. Pace D., Pollard A. J.. 2012; Meningococcal disease: clinical presentation and sequelae. Vaccine30:Suppl 2B3–B9 [CrossRef][PubMed]
    [Google Scholar]
  32. Pathan N., Faust S. N., Levin M.. 2003; Pathophysiology of meningococcal meningitis and septicaemia. Arch Dis Child88:601–607 [CrossRef][PubMed]
    [Google Scholar]
  33. Public Health Agency of Canada 2014; Invasive meningococcal disease.. http://www.phac-aspc.gc.ca/im/vpd-mev/meningococcal-eng.php
  34. Read R. C., Baxter D., Chadwick D. R., Faust S. N., Finn A., Gordon S. B., Heath P. T., Lewis D. J., Pollard A. J.. 2014; Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial. Lancet384:2123–2131 [CrossRef][PubMed]
    [Google Scholar]
  35. Riordan A.. 2014; Preventing meningitis and septicaemia: are we nearly there yet?. Lancet Infect Dis14:363–364 [CrossRef][PubMed]
    [Google Scholar]
  36. Robinson J. L., Canadian Paediatric Society, Infectious Diseases and Immunization Committee. 2014; Immunization for meningococcal serogroup B: What does the practitioner need to know?. Paediatr Child Health19:91–98
    [Google Scholar]
  37. Salvadori M., Bortolussi R.. 2011; Meningococcal vaccines in Canada: an update. Paediatr Child Health16:485–486
    [Google Scholar]
  38. Sopori M.. 2002; Effects of cigarette smoke on the immune system. Nat Rev Immunol2:372377 [CrossRef]
    [Google Scholar]
  39. Snape M. D., Pollard A. J.. 2013; The beginning of the end for serogroup B meningococcus?. Lancet381:785–787 [CrossRef][PubMed]
    [Google Scholar]
  40. Stephens D. S., Greenwood B., Brandtzaeg P.. 2007; Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet369:2196–2210 [CrossRef][PubMed]
    [Google Scholar]
  41. The Lancet Infectious Diseases 2014; The case for vaccinating against meningitis B. Lancet Infect Dis14:359 [CrossRef][PubMed]
    [Google Scholar]
  42. Tu H. A., Deeks S. L., Morris S. K., Strifler L., Crowcroft N., Jamieson F. B., Kwong J. C., Coyte P. C., Krahn M., Sander B.. 2014; Economic evaluation of meningococcal serogroup B childhood vaccination in Ontario, Canada. Vaccine32:5436–5446 [CrossRef][PubMed]
    [Google Scholar]
  43. Tuite A. R., Kinlin L. M., Kuster S. P., Jamieson F., Kwong J. C., McGeer A., Fisman D. N.. 2010; Respiratory virus infection and risk of invasive meningococcal disease in central Ontario, Canada. PLoS One5:e15493 [CrossRef][PubMed]
    [Google Scholar]
  44. Viner R. M., Booy R., Johnson H., Edmunds W. J., Hudson L., Bedford H., Kaczmarski E., Rajput K., Ramsay M., Christie D.. 2012; Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. Lancet Neurol11:774–783 [CrossRef][PubMed]
    [Google Scholar]
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