Recurrent invasive meningococcal infections – quantifying the risk, Germany, 2002 to 2018

Abstract

Invasive meningococcal disease (IMD) is a rare condition with a high case fatality rate. While most patients suffer from one single episode in life, there is anecdotal evidence for recurrent infection. Aim: The German National Reference Laboratory for Meningococci and Haemophilus influenzae (NRZMHi) analysed IMD cases from 2002 to 2018 to retrospectively quantify the risk of recurrent infection. Methods: Recurrent IMD was defined as detection of Neisseria meningitidis in a sample of the same patient more than 30 days after the first episode of IMD. Results: Among 5,854 patients with a median observation period of 9.4 years, 14 suffered a second IMD episode and one patient a third one. The risk of a recurrent IMD was 29.4 per 100,000 person-years for survivors of the first episode. Rare serogroups (Y, W, E and Z) were more common in patients with recurrent IMD (p < 0.0001). Discussion: Patients surviving IMD were at least at a 50-fold risk of another IMD episode compared with the general population. The study most likely underestimated the risk of recurrent infection. Increased risk may be due to undiagnosed complement deficiencies. The high risk of re-infection argues for vaccination of patients who have survived IMD. License, supplementary material and copyright This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence and indicate if changes were made.

Invasive meningococcal disease: Should the first episode prompt further investigation?

“…Forty to seventy percent of individuals with terminal complement deficits have at least one invasive N. meningitidis infection in the course of their life 6 . Survivors of a first IMD have a 50‐ to 70‐fold increased risk of a second IMD than the general population 7 …”

“…In recent years, an increasing number of studies advocate for complement deficiency screening after a first severe meningococcal infection, particularly in the presence of a rare serogroup 7–10 . Rameix‐Welti et al .…”

“…6 Survivors of a first IMD have a 50-to 70-fold increased risk of a second IMD than the general population. 7 In recent years, an increasing number of studies advocate for complement deficiency screening after a first severe meningococcal infection, particularly in the presence of a rare serogroup. [7][8][9][10] Rameix-Welti et al proposed five criteria for systematic screening that seemed to have a good positive predictive value, though still lacking validation: IMD before the age of 6 months or after 5 years old, family history of infection by N. meningitidis, recurrent infection, fulminant meningitis and infection by a rare serogroup.…”

“…7 In recent years, an increasing number of studies advocate for complement deficiency screening after a first severe meningococcal infection, particularly in the presence of a rare serogroup. [7][8][9][10] Rameix-Welti et al proposed five criteria for systematic screening that seemed to have a good positive predictive value, though still lacking validation: IMD before the age of 6 months or after 5 years old, family history of infection by N. meningitidis, recurrent infection, fulminant meningitis and infection by a rare serogroup. 5 Additionally, the National Institute for Health and Care Excellence (NICE) recommends testing for complement deficiency in the presence of 1 episode of invasive meningococcal disease caused by serogroups other than B.…”

Impfprophylaxe rekurrierender invasiver Erkrankungen mit Meningokokken

“…Rekurrente invasive Meningokokkeninfektionen wurden als Einzelfallberichte in der Literatur beschrieben und in einer aktuellen Arbeit für den Zeitraum 2002–2018 für Deutschland ausgewertet [ 3 ]. Risikofaktoren scheinen Komplementdefekte, bestimmte Lymphomerkrankungen (M. Waldenström) sowie IgG2-Subklassen-Defekte zu sein [ 4 , 5 ].…”