Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1–4 cross-sectional survey results

Abstract

Background The incidence of invasive meningococcal disease in the UK decreased by approximately four times from 1999 to 2014, with reductions in serogroup C and serogroup B disease. Lower serogroup C invasive meningococcal disease incidence was attributable to implementation of the meningococcal serogroup C conjugate vaccine in 1999, through direct and indirect protection, but no vaccine was implemented against serogroup B disease. UK Meningococcal Carriage surveys 1-3 (UKMenCar1-3), conducted in 1999, 2000, and 2001, were essential for understanding the impact of vaccination. To investigate the decline in invasive meningococcal disease incidence, we did a large oropharyngeal carriage survey in 2014-15, immediately before the changes to meningococcal vaccines in the UK national immunisation schedule. Methods UKMenCar4 was a cross-sectional survey in adolescents aged 15-19 years who were enrolled from schools and colleges geographically local to one of 11 UK sampling centres between Sept 1, 2014, and March 30, 2015. Participants provided an oropharyngeal swab sample and completed a questionnaire on risk factors for carriage, including social behaviours. Samples were cultured for putative Neisseria spp, which were characterised with serogrouping and wholegenome sequencing. Data from this study were compared with the results from the UKMenCar1-3 surveys (1999-2001).Findings From the 19 641 participants (11 332 female, 8242 male, 67 not stated) in UKMenCar4 with culturable swabs and completed risk-factor questionnaires, 1420 meningococci were isolated, with a carriage prevalence of 7•23% (95% CI 6•88-7•60). Carriage prevalence was substantially lower in UKMenCar4 than in the previous surveys: carriage prevalence

The decline of invasive meningococcal disease and influenza in the time of COVID ‐19: the silver linings of the pandemic playbook

“…In that landmark paper from 1918, six predisposing factors for IMD were observed: season, severe weather, antecedent epidemics of influenza, temporarily lowered resistance, overcrowding, and high carriage rates. This has held true for a century; and moreover, recent work from the United Kingdom correlates reductions in carriage‐promoting social behaviours with a reduction in IMD incidence, suggesting that public health policies aimed at influencing behaviour might further reduce this disease 4 . These observations resonate in 2022 as we reflect on the impact of broad scale public health measures taken during the COVID‐19 pandemic.…”

“…This has held true for a century; and moreover, recent work from the United Kingdom correlates reductions in carriage‐promoting social behaviours with a reduction in IMD incidence, suggesting that public health policies aimed at influencing behaviour might further reduce this disease. 4 These observations resonate in 2022 as we reflect on the impact of broad scale public health measures taken during the COVID‐19 pandemic.…”

Impact of meningococcal ACWY conjugate vaccines on pharyngeal carriage in adolescents: evidence for herd protection from the UK MenACWY programme

“…14 The UK Meningococcal Carriage (UKMenCar1-4) surveys demonstrated the impact of herd protection from the MCC vaccine, and highlighted behaviours that increase the risk of meningococcal carriage and transmission. 4,15,16 UKMenCar4 was conducted in 2014-2015 just prior to the introduction of the MenACWY vaccination programme. The subsequent 'Be on the TEAM (Teenagers Against Meningitis)' study (ISRCTN75858406) commenced in 2018 using compatible methods.…”

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

“…Living in overcrowded environments (e.g., dormitories), intercurrent viral respiratory tract illness, active or passive smoking or smokeless tobacco, intimate contact, and, frequenting bars or clubs have all been identified as factors that increase the probability of carriage. Nm carriage rate was linked to previous-month upper respiratory tract illness, antibiotic use in the preceding month, and the presence of many household members in this study [4,[6][7][8][9][10][11]15,21]. Spyromitrou-Xioufi et al [22] recently published a systematic review and meta-analysis about the risk factors for meningococcal disease in children and adolescents.…”

“…IMD and Nm carriage serogroup distribution varies by geographical region and changes over time within the same geographical region [11]. The seroepidemiology of meningococcal illness in Turkey is dynamic and distinct from that in other countries [12].…”