The Epidemiology of Meningococcal Disease and Carriage, Genotypic Characteristics and Antibiotic Resistance of Neisseria meningitidis Isolates in Zhejiang Province, China, 2011–2021

Abstract

Neisseria meningitidis (Nm) remains a worldwide leading cause of epidemic meningitis. During 2011–July 2021, 55 meningococcal disease (MD) cases were reported with a case fatality rate of 5.45% in Zhejiang Province, China. The median age was 7 years. The annual incidence was 0.0017–0.0183 per 100,000 population. The highest age-specific incidence was observed in the group younger than 1 year. Serogroup was identified in 30 laboratory-confirmed MD cases, and MenB was most predominant. MenB was mainly observed in two age groups: younger than 5 and older than 35 years. MenB incidence was significantly increasing from 0.0018 per 100,000 in 2013 to 0.0070 per 100,000 in 2019. During 2015–2020, 17 positive samples were detected from 2,827 throat swabs from healthy population, of which 70.59% was MenB. Twenty multilocus sequence typing sequence types (STs) containing eight newly assigned STs (ST15881–ST15888) were determined in all Nm isolates. Either in MD cases or in healthy population, MenB CC ST-4821 was the predominant ST. It was worth noting that two MenY CC ST-23 cases occurred in 2019 and 2021, respectively. MenY CC ST-23 MD cases increased gradually in China. Phylogeny results based on genome sequencing indicated that Chinese MenW CC ST-11 isolates were genetically linked and grouped together with Japanese isolates, separated from MenW CC ST-11 isolates from Saudi Arabia Hajj outbreak, Europe, South Africa, South America, North America, and Oceania. MenW CC ST-11 isolates from East Asia might have evolved locally. Antibiotic susceptibility tests revealed a relatively high resistance rate (22.86%) of Nm isolates to penicillin. This study provided valuable data for Chinese public health authorities to grasp the temporal epidemiological characteristics of MD and healthy carriage.

Penicillin and Cefotaxime Resistance of Quinolone-Resistant Neisseria meningitidis Clonal Complex 4821, Shanghai, China, 1965–2020

“…We discovered more Pen NS isolates from carriers after 2007 and from patients after 2013 in Shanghai, although penicillin-intermediate meningococcus arose initially in 1967 (MIC 0.125 µg/mL; penA379; carrier; Appendix 1 Table 2). Our study presents the increasing trend of penicillin nonsusceptibility among N. meningitidis isolates in China during 1965-2020 (Figure 1), which is also supported by data from the China CDC and the Zhejiang CDC (15)(16)(17). This trend is similar to trends in other parts of the world, such as North America (≈30%), Europe (≈40%), and Australia (≈90%) (27)(28)(29).…”

“…Nevertheless, the isolates were phylogenetically related to the invasive meningococci in China, possessing representative features as demonstrated previously (5,7,39,40). The trend of increasing Pen NS meningococci in China provided additional evidence for this study (15)(16)(17). Another limitation is that the penA184 and penA866 alleles were represented by only 1 penicillin-intermediate isolate each, which did not meet the requirements for the definition of Pen NS penA alleles (14), although genetic transformations supported the contributions to the phenotype.…”

“…Two studies from the China Center for Disease Control and Prevention (China CDC) showed that the Pen NS proportion was 4.9% during 2003–2012 and 15.2% during 2005–2019 nationwide and that 2.6% of isolates showed intermediate resistance to cefotaxime (without MIC values) during 2005–2019 ( 15 , 16 ). A provincial study from Zhejiang showed a Pen NS proportion of 51.4% during 2011–2021 ( 17 ). However, information regarding the resistance mechanism and the genetic origin is unavailable.…”