Carriage of Neisseria Meningitidis in Low and Middle Income Countries of the Americas and Asia: A Review of the Literature

Abstract

Introduction: Meningococcal colonization, or carriage, can progress to invasive meningococcal disease, a serious public health concern, with rapid progression of disease and severe consequences if left untreated. Information on meningococcal carriage and epidemiology in low/middle income American and Asian countries remains sparse. These data are crucial to ensure that appropriate preventive strategies such as vaccination can be implemented in these regions. The goal of this study was to summarize the Neisseria meningitidis carriage literature in low and middle income countries of the Americas and Asia. Methods: Target countries were categorized as low and middle income according to the International Monetary Fund classification of low income/developing economies and middle income/emerging market economies, respectively. A PubMed search identified Englishlanguage publications that examined carriage in these countries. Studies reporting the epidemiology of N. meningitidis carriage or assessing risk factors for carriage were included. Results: Fourteen studies from the Americas [Brazil (n = 7), Chile (n = 3), and Colombia, Cuba, Mexico, and Paraguay (n = 1 each)] and nine from Asia [China (n = 2), India (n = 3), and Malaysia, Nepal, Philippines, and Thailand (n = 1 each)] were identified; an additional Cuban study from the authors' files was also included. Studies were not identified in many target countries, and substantial diversity was observed among study methodologies, populations, and time periods, thereby limiting comparison between studies. The carriage rate in the Americas ranged from 1.6% to 9.9% and from 1.4% to 14.2% in Asia. Consistent risk factors for carriage were not identified. Conclusions: There is a lack of comprehensive and contemporary information on meningococcal carriage in low and medium income countries of the Americas and Asia. Future Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare. 11962566.

The Burden of Invasive Vaccine-Preventable Diseases in Adults in the Middle East and North Africa (MENA) Region

“…In addition, some consistencies with epidemiological data from other regions were noted. For instance, the limited data on meningococcal carriage that were identified are generally consistent with publications of other countries outside of the MENA region, with carriage rates between 1.4 and 14.2% reported across all ages in low-and middle-income countries of the Americas and Asia and up to 2% in Africa CAP community-acquired pneumonia, CFR case fatality rate, CSF cerebrospinal fluid, Hib H. influenzae type B, PCR polymerase chain reaction [71,72]. Additionally, studies from western regions and sub-Saharan Africa have also reported an association between smoking and carriage [73][74][75].…”

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“…However, almost all cases of IMD are caused by one of six meningococcal serogroups: A (MenA), B (MenB), C (MenC), W (MenW), Y (MenY) and X (MenX). Their relative importance as causative agents vary considerably across geographical locations and time periods [1,3,7].…”

Nasopharyngeal Meningococcal Carriage among Children and Adolescents in Turkey in 2018: An Unexpected High Serogroup X Carriage

“…Recently, the rate of Nm carriage in Paraguay was low (2.1%) among individuals aged 3 to 21 years [19]. In the Americas, the carriage rate ranged from 1.6% to 9.9%, whereas in Asia, it ranged from 1.4% to 14.2% [9]. In North America and Europe comparing adolescent time, the carriage rates during the first year of life are quite low, presumably because of social behavior throughout adolescence [6].…”

“…Nm carriage is found in 3-20% of the population s healthy people [3]. Nm carriage has been linked to age, crowded living conditions, cigarette smoke exposure, a history of respiratory infection, certain adolescent social behavior, and antibiotic use [4,[6][7][8][9][10]. Adolescents and young adults have the highest carriage rate [7].…”