Neisseria meningitidis phenotypic markers and septicaemia, disease progress and case-fatality rate of meningococcal disease: a 20-year population-based historical follow-up study in a Danish county

Abstract

The incidence rate (IR) and case-fatality rate (CFR) of meningococcal disease increased during the late 1980s and early 1990s in North Jutland County, Denmark. We examined the hypothesis that phenotypic markers of Neisseria meningitidis are predictors of septicaemia with or without meningitis, rapid disease progress and fatal outcome of meningococcal disease and we studied whether changes in IR and CFR over time might be related to emergence or spread of certain phenotypes. This follow-up study was based on a complete registration of 413 cases of meningococcal disease in North Jutland County during 1980-99. Phenotypic markers included serogroup, serotype and serosubtype. A complete phenotype was available for 315 cases (76 %); 100 (32 %) strains were phenotype B : 15 : P1.7,16 and 31 (10 %) were C : 2a : P1.2,5. Septicaemia without meningitis was less common in cases with B : 15 : P1.7,16 and C : 2a : P1.2,5 strains. No association was found between phenotype and rapid disease progress. The overall CFR was 12 %. An increased CFR was associated with phenotypes B : 15 : P1.7,16 [odds ratio (OR) 2·8, 95 % confidence interval (CI) 1·2-18·5] and C : 2a : P1.2,5 (OR 5·2, 95 % CI 1·6-16·4) when compared with other phenotypes. The prevalence of B : 15 : P1.7,16 strains increased gradually during the study period and the CFR increased from 8 % during 1980-89 to 19 % during 1990-99, although the CFR for other phenotypes also increased. The CFR for C : 2a : P1.2,5 remained high ($20 %), but the contribution of this phenotype to the overall CFR decreased during the study period. In conclusion, phenotypes B : 15 : P1.7,16 and C : 2a : P1.2,5 were predictors of an increased CFR. The high prevalence of phenotype B : 15 : P1.7,16 contributed to increased overall IR and CFR during 1990-99.

Emergence of serogroup C meningococcal disease associated with a high mortality rate in Hefei, China

“…This was of borderline statistical significance and factors associated with death in univariate analysis were age of 15–24 years, infection with serogroup C, and meningococcemia. The results of this study confirm the severity of serogroup C disease [18,19]. The reason for the high virulence of this particular strain of N. meningitidis is unknown, but the strain is associated with a high frequency of meningococcemia with severe complications, which was of statistical significance in multivariable analysis.…”

“…Few published papers discuss the clinical characteristics of serogroup C meningococcal disease [18-20]. We reviewed the detailed clinical information and found serogroup C disease more likely to cause meningococcemia, decreased platelet counts, and serious complications.…”

Significance of Meningococcal Hyperinvasive Clonal Complexes and Their Influence on Vaccines Development

“…This can be due to the fact that ST-11CC isolates more frequently cause septicemia than meningitis and mortality from septicemia is generally higher (Rosenstein et al, 2001). It was also interesting that outbreaks caused by the mentioned clone affected mainly teenagers and young adults (Ashton et al, 1991;Jensen et al, 2003;Krizova and Musilek, 1995;Skoczynska et al, 2013;Smith et al, 2006;Trotter et al, 2002). Because of frequent outbreaks occurrence, significant increase in incidence and higher mortality, massive immunization campaigns were carried out.…”

Recent epidemiological changes in meningococcal disease may be due to the displacement of serogroup A by serogroup C in Hefei city, China

“…The overall CFR for meningococcal disease in Hefei city (7.3%) is lower than that reported in New York City (16.9%, 1989–2000),28 New England (10%, 1993–98),29 western Norway (17%, 1994–2002),30 and Denmark (12%, 1980–99),31 and higher than that in Antwerp (6.7%, 2001) 32. There are four possible reasons for the differences.…”