Meningococcal disease: History, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention

Abstract

Meningoccocal disease has repeatedly caused outbreaks worldwide. There has been sudden surge of cases of meningococcemia and meningococcal meningitis in early 2005 in Delhi, India and neighboring states of Uttar Pradesh and Haryana. As of June 17, 2005, 429 probable cases of meningococcal disease have been reported in Delhi out of which 128 cases have revealed microbiological evidence of Neisseria meningitidis. It is possible that the number of cases was in excess of the numbers notified. During this episode drug susceptibility testing by MIC method (E-test) using break points recently recommended by NCCLS/CLSI, revealed that all isolates were sensitive to penicillin, ampicillin, rifampicin and ceftriaxone. As regards to ciprofloxacin, about two third of the isolates tested were found to be 'nonsusceptible' (MIC =0.03µg/mL-0.190µg/mL). All the isolates were found resistant to cotrimoxazole (MIC> 16µg/mL). Repeated outbreaks, decreased susceptibility to ciprofloxacin, which is commonly used for chemoprophylaxis of meningococcal disease, highlights the need for a constant surveillance system. Present review deals with various aspects of Neisseria meningitidis and meningococcal disease in view of recent episode.

Safety and Immunogenicity of Two Doses of Quadrivalent Meningococcal Conjugate Vaccine or One Dose of Meningococcal Group C Conjugate Vaccine, both Administered Concomitantly with Routine Immunization to 12‐ to 18‐Month‐Old Children

“…Although only a small proportion of carriers develop invasive meningococcal disease (IMD), Neisseria meningitidis is nevertheless responsible for substantial worldwide morbidity and mortality, causing both epidemic and endemic disease. Worldwide incidence varies widely from fewer than one to three cases per 100,000 population in developed nations, to 10 to 25 cases per 100,000 in developing countries (1). The most common clinical presentations are meningococcemia and purulent meningitis, with nearly all clinical disease caused by five meningococcal serogroups: A, B, C, Y and W (formerly ‘W-135’ and now ‘W’, as per Harrison et al [2]) (2,3).…”

Ciprofloxacin-ResistantNeisseria meningitidis, Delhi, India

“…Meningococcal disease is endemic in India, and sporadic cases of meningococcal meningitis have occurred in Delhi in previous years ( 1 ). During 1966, 616 cases of meningitis were reported; case-fatality rate was 20.9%.…”

“…In 1985, an outbreak of greater magnitude had 6,133 cases with 799 deaths (13%). An outbreak of meningococcal meningitis also occurred in Delhi during April–July 2005 ( 1 ), and the disease reappeared in January–March 2006.…”

Meningococcal disease in Asia: an under-recognized public health burden

“…Large meningococcal serogroup A epidemics originating in China spread to Mongolia in 1973–1974 and 1994–1995 [75, 76]. During the 1994–1995 epidemic, the overall attack rate ranged between 80 and >90/100 000, but reached 179/100 000 in the capital city of Ulaanbaator [23].…”

“…Epidemic meningococcal disease was not reported in Nepal until 1982 when a large meningococcal serogroup A outbreak occurred in the Kathmandu Valley with an overall attack rate of 103/100 000 [25, 75, 77]. Incidence and mortality was highest in infants aged <1 year (221/100 000 and 26%, respectively).…”