A critical analysis of serogroup B meningococcal disease burden in Brazil (2001–2015): implications for public health decisions

Abstract

The recent licensure of two different serogroup B recombinant protein meningococcal vaccines in Brazil emphasizes the importance of a better knowledge of the real burden of serogroup B meningococcal (MenB) disease to establish evidence-based vaccination policies. We performed an observational, descriptive study, from 2001 to 2015, analyzing the incidence and case fatality rates (CFR) of MenB disease in Brazil, according to age group and region. In the absence of any vaccine use targeting MenB disease, a significant decline of 90% in the overall incidence rates of MenB disease was observed (from 0.55 cases/100,000 habitants in 2001 to 0.05 in 2015), with declines found in all age groups during the study period. The highest incidence rates were consistently observed in infants and children 1-4 year of age, whereas adults ≥ 60 years experienced the highest CFR (33.9%). The proportion of cases with serogroup identified increased from 37.1% in 2001 to 51.5% in 2015. Despite an improvement in recent years, the quality of diagnosis is highly heterogeneous in the diverse regions, presenting important deficiencies that still prevent the possibility of a robust and reliable analysis of the burden of the meningococcal disease in Brazil. Based on the findings of this study and taking in account the unlikely indirect effect associated with the use of the new recombinant serogroup B protein vaccines, infants < 1 year is the age group to be prioritized when considering the implementation of routine immunization programmes with MenB vaccines.

Genomic surveillance of Neisseria meningitidis serogroup B invasive strains: Diversity of vaccine antigen types, Brazil, 2016-2018

“…After its introduction by the NIP, MCC vaccination was considered to be highly effective in Brazil based on the reduction of IMD caused by serogroup C in infants [3]. Although we observed a downward trend of IMD following the introduction of the MCC vaccine, from 1.54 per 100,000 in 2010 to 0.54 per 100,000 habitants in 2018, and observed a significant declining trend in incidence rates of serogroup B IMD cases [4] The structural similarity between the serogroup B polysaccharide and fetal brain-cell adhesion molecules makes the B polysaccharide a poor immunogen [5]. This similarity reduces the ability to elicit bactericidal antibodies and raises concerns about possible autoimmunity.…”

“…After its introduction by the NIP, MCC vaccination was considered to be highly effective in Brazil based on the reduction of IMD caused by serogroup C in infants [ 3 ]. Although we observed a downward trend of IMD following the introduction of the MCC vaccine, from 1.54 per 100,000 in 2010 to 0.54 per 100,000 habitants in 2018, and observed a significant declining trend in incidence rates of serogroup B IMD cases [ 4 ] ( S1 Fig ), meningococcal serogroup B (MenB) remains the prominent cause of IMD in Brazil, particularly in infants, with 1.5 cases per 100,000 habitants in 2018 ( S2 Fig ).…”

Surveillance of invasive meningococcal disease in the south of Brazil: considerations of immunization programme

“…The key limitation of this study is that IMD notification is mandatory in Brazil although underreporting remains a problem. Despite an improvement in the quality of diagnosis, particularly in states as in the south where molecular-based typing diagnosis has been incorporated in the surveillance system, the quality of diagnosis remains highly heterogeneous and many cases are not reported [12]. Furthermore, in many cases the serogroup is not identified.…”

“…1 IMD notification is mandatory in Brazil. A confirmed case is defined by the presence of at least one of the following: isolation of N. meningitidis from a normally sterile site, detection of bacterial DNA by PCR, antigen detection, clinical-epidemiological criteria (close contact with a laboratory-confirmed case), Gram-staining or clinical criteria (patient with suggestive symptoms and petechial or purpuric rash) [12].…”

Are we able to prevent invasive meningococcal disease in Brazil?

“…Furthermore, up to 20% of survivors suffer permanent damage, including deafness, brain injuries, and amputated limbs. Currently, six serogroups (A, B, C, W, X, and Y) are responsible for most IMD cases (Chicuto, de Moraes, Cassio de Moraes, & Safadi, 2020;Morello, Milazzo, Marshall, & Giles, 2021; M. A. P. Safadi et al, 2017;Xu et al, 2022).…”