Underestimation of Invasive Meningococcal Disease in Italy

Azzari, Chiara; Nieddu, Francesco; Moriondo, Maria; Indolfi, Giuseppe; Canessa, Clementina; Ricci, Silvia; Bianchi, Leila; Serranti, Daniele; Poggi, Giovanni Maria; Resti, Massimo

doi:10.3201/eid2203.150928

Cited by 36 publications

(41 citation statements)

References 22 publications

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“…The better quality of the data available from our surveillance systems is thanks mainly to the serological characterisation of the circulating meningococcal strains provided by microbiology laboratories, and molecular typing reduces the underestimation of cases resulting from cultures alone. 34 The routine integration of different databases to build a single, web-based system in which all the actors (physicians, laboratorians, public health workers, emergency room workers and so on) can promptly input all the information on IMD at their disposal is crucial to the successful implementation and assessment of targeted prevention strategies and fundamental to public health decision-making.…”

Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system

et al. 2017

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BackgroundEpidemiology of Neisseria meningitidis has been changing since the introduction of universal vaccination programmes against meningococcal serogroup C (MenC) and meningococcal serogroup B (MenB) has now become dominant. This study aimed to analyse the cases reported in institutional data recording systems to estimate the burden of invasive meningococcal diseases (IMDs) and assess the effectiveness of surveillance in Veneto region (Italy).MethodsAnalysis was performed from 2007 to 2014 on data recorded in different systems: Mandatory Notification System, National Surveillance of Invasive Bacterial Diseases System and Laboratories Surveillance System (LSS), which were pooled into a combined surveillance system (CSS) and hospital discharge records (HDRs). A capture-recapture method was used and completeness of each source estimated. Number of cases with IMD by source of information and year, incidence of IMD by age group, case fatality rate (CFR) and distribution of meningococcal serogroups by year were also analysed.ResultsCombining the four data systems enabled the identification of 179 confirmed cases with IMD, achieving an overall sensitivity of 94.7% (95% CI: 90.8% to 98.8%), while it was 76.7% (95% CI: 73.6% to 80.1%) for CSS and 77.2% (95% CI: 74.1% to 80.6%) for HDRs. Typing of isolates was done in 80% of cases, and 95.2% of the typed cases were provided by LSS. Serogroup B was confirmed in 50.3% of cases. The estimated IMD notification rate (cases with IMD diagnosed and reported to the surveillance systems) was 0.48/100 000 population, and incidence peaked at 6.2/100 000 in children aged <1 year old (60.9% due to MenB), and increased slightly in the age group between 15 and 19 years (1.1/100 000). A CFR of 14% was recorded (8.7% in paediatric age).ConclusionsQuality of surveillance systems relies on case ascertainment based on serological characterisation of the circulating strains by microbiology laboratories. All available sources should be routinely combined to improve the epidemiology of IMD and the information used by public health departments to conduct timely preventive measures.

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Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system

et al. 2017

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“…This observational study was conducted retrospectively from January 2006 to August 2018 and evaluated all children admitted to Italian hospitals with the diagnosis of IPD based on data from the national Molecular Surveillance Register (MSR). As previously described [17], the MSR was started at the Immunology and Infectious Diseases Laboratory, Meyer Children's Hospital, Florence, Italy, (hereinafter "central lab") in 2006 and it was further expanded thanks to dedicated funds from the Italian Center for Disease Control (CCM). Participation of all Italian pediatric units and hospitals was encouraged but it was not mandatory.…”

Section: Methodsmentioning

confidence: 99%

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Severe Invasive Disease Caused by Serotype 3 Streptococcus Pneumoniae in Italian Children

et al. 2019

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The effectiveness and impact of the 13-valent pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal diseases (IPD) due to serotype 3 (ser3) has been questioned. However, the impact of PCV13 on different clinical presentations of ser3-IPD has not been studied so far. The impact of PCV13 on different clinical presentations of ser3-IPD in a population of Italian children aged 0–8 years was evaluated, comparing pre- and post-PCV13 introduction period. Real-time polymerase chain reaction (PCR) was used for the diagnosis and serotyping of IPD. During the observation period (1 January 2006–1 August 2018), ser3 was detected in 60/284 (21.1%) children under 8 with serotyped IPD. The incidence of sepsis and meningitis was 0.24 per 1,000,000 person-years (p-y) in pre-PCV13 and 0.02 per 1,000,000 p-y in post-PCV13. No cases occurred in vaccinated children. In the post-PCV13 period, case reduction was 13% for all ser3 IPD and 92% for sepsis and meningitis. Vaccination impact may be underestimated due to significant improvement in pneumococcal surveillance in post-PCVC13. Our data suggest a significant impact of PCV13 on meningitis and sepsis due to ser3 and a lower impact against pneumonia. While waiting for increasingly effective anti-pneumococcal vaccines, PCV13, which guarantees protection against the most severe clinical presentations of ser3-IPD, is currently the most effective prevention option available.

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“…In fact, it is a facultative intracellular pathogen that can be easily altered (autolysis) at temperatures less than 37°C. So it is recommended to transport it quickly at 37°C and to cultivate the CSF less than one hour after collection of the sample [30]. Unfortunately, these recommendations are not continually respected.…”

Section: Discussionmentioning

confidence: 99%

Molecular diagnosis of bacterial meningitis by multiplex real time PCR in Tunisian children

Haddad-Boubaker

Lakhal

Fathallah

et al. 2018

J Infect Dev Ctries

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Introduction: Bacterial meningitis is a medical emergency requiring a fast and reliable diagnosis. Molecular methods such as real-time PCR (rt-PCR) offer an attractive alternative. Thus, this study aims to establish multiplex rt-PCRs detecting N. meningitidis, S. pneumoniae and H. influenzae b from cerebrospinal fluid in Tunisian children beyond neonatal age. Methodology: Using bioinformatic tools and experimentation, we validated the specificity and optimal criteria of PCRs for primers and probes of plyA (S. pneumoniae), ctrA and sodC (N. meningitidis) and bexA genes (H. influenzae b). We performed one multiplex RT-PCR for detection of S. pneumoniae and N. meningitidis targeting plyA and ctrA, sodC genes respectively, simultaneously with a singleplex RT-PCR for H. influenzae b. The sensitivity and specificity of our methods were assessed. Then, we tested our methods for 122 CSF samples collected from suspected meningitis cases between 2014 and 2016 in Bechir Hamza Children’s Hospital of Tunis. Results: Our results have shown the sensitivity of the designed PCRs was up to 10-4 DNA dilution and the specificity was 100%. PCR evaluation has shown 51 positive samples: 38 of pneumococcal cases, 12 meningococcal cases, 1 case of H. influenzae b with 8.57% and 50% of supplementary positive cases rates respectively. Conclusions: Our assay proved to be very sensitive, specific and rapid for bacterial meningitis diagnosis. In the recent context of Hib vaccination, the possibility of detecting S. pneumoniae and N. meningitidis separately constitute an attractive opportunity. Nevertheless, simultaneous detection of Hib remains relevant in specific clinical context and for epidemiologic study.

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Underestimation of Invasive Meningococcal Disease in Italy

Abstract: Underestimation is attributable to misdiagnosis, especially in fatal cases, and use of insufficiently sensitive laboratory methods.

Cited by 36 publications

References 22 publications

Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system

Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Severe Invasive Disease Caused by Serotype 3 Streptococcus Pneumoniae in Italian Children

Molecular diagnosis of bacterial meningitis by multiplex real time PCR in Tunisian children

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