Community outbreak of serogroup B invasive meningococcal disease in Beaujolais, France, February to June 2016: from alert to targeted vaccination

Abstract

In February and March 2016, four cases of serogroup B invasive meningococcal disease (IMD) occurred over 3 weeks in a small area north of Lyon in the Auvergne-Rhône-Alpes region, France. There were no deaths but two cases had sequelae. This community outbreak was caused by a rare meningococcal strain of the clonal complex ST-32, covered by the 4CMenB/Bexsero vaccine. The incidence rate for serogroup B IMD in this area was 22.5 per 100,000 inhabitants, which is above the epidemic threshold (10/100,000). The number of cases observed was significantly higher than expected in the age group of 0–24 year-olds (standardised incidence ratio: 96). These results suggested the potential emergence of this invasive strain in this sub-population. In accordance with French recommendations, it was decided to vaccinate the population aged between 2 months and 24 years, living, working or studying in the epidemic area. The vaccination campaign took place from April to September 2016. Vaccination coverage was estimated at 47% for one dose and 40% for two doses. The lowest coverage estimations were observed for the age groups younger than 3 and 15–19 years. Enhanced epidemiological and microbiological surveillance reported a fifth case in June 2016, outside the epidemic area.

Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination

“…Accelerated introduction of the National MenC Programme for years 10, 11 and 12 at the school and expanded to years 7, 8 and 9 [ 78 ] Sydney 2008 B 2–13 y 3 10.7 0 No vaccine available [ 133 ] Central Australia Indigenous communities 2017 W ≤ 4 y 24 10.9 0 MenACWY-CV for 1–19 y (indigenous then also non-indigenous). 6 additional cases, all unimmunised [ 80 ] Tasmania 2018 W – 3 – – State-wide campaign with MenACWY-CV expanded to 6 w–21 y [ 134 ] New Zealand New Zealand 1991–1996 B < 5 y 473 in 1996 14.0 (142 in < 1 y, 549.6 in Maori < 1 y) ~ 5 Development of MeNZB (Chiron) with implementation from 2004 [ 60 , 135 ] Northland 2011 C – – – – MenC-CV for 1 to < 20 y 1 case in unvaccinated infant [ 14 ] Northland 2018–2019 …”

“…Vaccines were administered at clinics set up in schools and day care centres, ad hoc clinics provided by local councils, and public health centres. No further cases occurred within the epidemic area [ 60 ].…”

“…Many of the challenges associated with implementing mass vaccination campaigns were common to high- and low-income countries and were centred around acquiring sufficient numbers of vaccine doses in a short time frame, rapid dissemination of information to healthcare professionals and the affected community, and accessing the target population. Vaccine availability was most problematic in countries where the vaccine was not included in the NIP, adding to delays between outbreak onset and implementation of a vaccination programme [ 58 , 60 , 61 , 73 , 86 – 90 ]. The logistics involved with accessing the target population differed in high- versus low-income countries, with apathy, particularly among students and young adults, or reluctance to identify close contacts (recreational drug users) negatively impacting uptake in high/upper-middle-income countries [ 49 , 69 , 77 ].…”

Outbreak of invasive meningococcal disease caused by a meningococcus serogroup B in a nursery school, Wallonia, Belgium, 2018

“…One difficulty in the management of this outbreak was taking the decision to recommend mass vaccination in the school classes. Since the vaccines 4CMenB and rLP2086 became available in Europe in 2013, mass vaccination has frequently been organised in MenB outbreak situations [ 8 , 20 , 21 , 24 , 30 ]. In England, although new cases were detected after chemoprophylaxis during outbreaks, which was because of the different meningococcal serogroups; no cases occurred after vaccination [ 8 ].…”

Epidemiological profile of Neisseria meningitidis in Casablanca, Morocco: 2010–2019

“…In the USA, the incidence of the disease is higher in the age group between 1 and 4 years [ 14 ]. In France, the IMD notification rate is highest in infants younger than 1 year, followed by children aged 1–4 years [ 15 ].…”