Enfermedad por meningococo, Neisseria meningitidis: perspectiva epidemiológica, clínica y preventiva

Abstract

Bacterial meningitis constitutes a significant global public health problem. In particular, Neisseria meningitidis continues to be a public health problem among human populations in both developed and developing countries. Meningococcal infection is present as an endemic and an epidemic disease. Meningococcal disease is manifested not only as meningitis, but also as meningococcemia. The latter is usually fulminant. The global persistence of N. meningitidis is due to the significant number of carriers and the dynamics of transmission and disease. Approximately 500 million people worldwide are carriers of the bacterium in their nasopharynx. Multiple factors have been identified that predispose to the transmissibility of N. meningitidis, including active or passive inhalation tobacco smoking, upper viral respiratory tract infections, drought seasons, and overcrowding. These factors explain the frequent occurrence of outbreaks in military barracks, schools, prisons, and dormitories. Some of the determinants of invasiveness of the bacteria include nasopharyngeal mucosal damage in colonized individuals, virulence of the strains, absence of bactericidal antibodies, and deficiencies of the complement system. During both endemic and epidemic scenarios of meningococcal disease, control measures should include treating the cases with appropriate antimicrobial therapy (penicillin, ceftriaxone, or chloramphenicol); providing chemoprophylactic drugs to contacts (rifampin or ciprofloxacin), and close observation of contacts. Nevertheless, the key to effective control and prevention of meningococcal disease is immunoprophylaxis. Available vaccines include the polysaccharide monovalent, bivalent (serogroups A, C), or tetravalent (A, C, Y, W-135 serogroups) vaccines; conjugate vaccine (serogroup C); and the combined vaccine with outer membrane proteins and polysaccharide (serogroups B, C). Due to a recent increase in case reporting of serogroup C N. meningitidis in Mexico, we have developed a national response strategy that includes availability of vaccines and medications for chemoprophylaxis. This review aims at providing health care workers with updated information regarding the epidemiological, clinical, and preventive aspects of meningococcal disease. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Pediatric meningitis due to Neisseria meningitidis, Streptococcus pneumoniae and Group B Streptococcus in Tijuana, Mexico: active/prospective surveillance, 2005–2018

“…The data presented in this, long, active-surveillance-based study, confirm that, contrary to what has been reported in one publication in Mexico, 5 N. meningitidis is the leading cause of BM in Tijuana, Mexico, with serogroup C being the most prevalent. This study, along with an active-surveillance publication from nine hospitals in Mexico, and an outbreak of meningococcal BM caused by serogroup C, with clonal complex ST-11 (mortality >35%) in Tijuana during 2013, 20,21 confirmed that meningococcal disease is endemic in the region, and universal vaccination should be seriously considered.…”

“…In Mexico, based on previous published data, BM due to Neisseria meningitidis is considered to be a rare condition, with a total number of cases in the whole country as low as two per year. 5…”

Burden of Neisseria meningitidis infections in China: a systematic review and meta–analysis

“…The low carriage rates found in our study and those reported in Mexico are consistent with the low disease incidence rate reported in these two countries. Currently the burden of meningococcal disease in Mexico is low, with total national cases as low as two per year [73,74]. The prevalence of N. meningitidis carriage in healthy children and adolescents aged 10–19 years in Chile was reported to be 6.5% [75], and slightly lower in university students ages 18–24 years (4%) [76].…”

The epidemiology of meningococcal disease in Latin America 1945–2010: an unpredictable and changing landscape

“…Data for Mexico and Brazil associated with epidemics were identified for the late 1940s, with about 753 registered cases in Mexico seen for the period 1945–1949 [23] and a serogroup A epidemic from 1945 to 1951 in Sao Paulo, Brazil with incidence rates of 4·6–24·2 cases/100 000 inhabitants [24, 25]. Due to scarcity of more historical data, the following sections focus on the epidemiology from 1970 onwards.…”

“…Notably, Mexico has remained relatively unaffected since the 1940s and reports very low incidence of disease [23, 26]. SINAVE (Sistema Nacional de Vigilancia Epidemiológica) registered an average of 65 confirmed cases per year between 2003 and 2009 and, based on a total of 60 reported cases in 2006, a national incidence of 0·056 cases/100 000 has been estimated.…”