Characteristics of Neisseria meningitidis isolates causing fatal disease

Abstract

The objectives of the present study were to describe a selection of characteristics of all available fatal meningococcal isolates (n = 62) and to compare these with all the other invasive isolates (non-fatal, n = 474) collected in Sweden from 1995 to 2004 (fatality rate of 12%). The coverage of the fatal isolates by presently discussed outer membrane vesicle (OMV) vaccines was also estimated. The isolates were characterized by serogroup, serotype, genosubtype, multilocus sequence type and antibiogram. Basic epidemiological data were gathered. The results of the fatal isolates showed 55% serogroup B, 27% C, 15% Yand 3% W-135, with a fatality rate of 11% for B, 12% for C, 17% for Y and 8% for W-135. Characteristics associated with higher mortality were age, gender, serogroup Y, serotype 14 and 15 and genosubtypes P1.7,16-29,35 and P1.5-1,10-4,36-2. In contrast, non-14/non-15 serotypes, the genosubtypes P1.5-1,10-8,36-2; P1.7-2,4,37 and P1.7,16,35, as well as reduced sensitivity for penicillin G were associated with decreased mortality. The presently discussed OMV vaccines could, based solely on the complete genosubtype, theoretically cover up to 44% of the fatal serogroup B cases and up to 100% if every variable region by itself is capable to induce protective immunity.

Cost-effectiveness of vaccination against meningococcal B among Dutch infants

“…A weighted average CFR of 6% was obtained from 7 studies in Europe using data after 1990. 4,[28][29][30][31][32][33] Our results show that routine infant vaccination against MenB-related disease is far more expensive per QALY gained than routine vaccination against MenC-related disease 13 or human papilloma virus, which was recently implemented in the Dutch national immunization program. 34 Cost-effectiveness analyses in England also indicate that vaccinating against MenB disease is cost-effective only when the vaccine is inexpensive (£7,-) using a threshold of £30,000 per QALY.…”

Genetic characterisation of the emerging invasive Neisseria meningitidis serogroup Y in Sweden, 2000 to 2010

“…Clone YI does not seem to be related to increased mortality, although a difference would be difficult to detect because of the low incidence of meningococcal disease in general. The mortality rate of all the studied invasive serogroup Y isolates (13%) is within the range of the overall global mortality rate for meningococcal disease caused by all serogroups (about 10%) [2], but is considerably lower than the mortality rate for disease due to serogroup Y in Sweden in 1995 to 2005 (17%) [26].…”

Meningococcal Disease in Children in Merseyside, England: A 31 Year Descriptive Study

“…The overall European picture has been similar to that in the United Kingdom, with overall case-fatality rates falling and the incidence of serogroup C disease also falling [9], [10], [11].…”

“…In the United Kingdom, case fatality rates have been falling steadily since 1985, a trend which has been attributed to more efficient ascertainment of milder surviving cases [4] , improvements in clinical management [6] , [7] , and the introduction of the meningococcal C conjugate vaccine [8] . The overall European picture has been similar to that in the United Kingdom, with overall case-fatality rates falling and the incidence of serogroup C disease also falling [9] , [10] , [11] .…”