Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

Campbell, Helen; Andrews, Nick; Parikh, Sydel R.; Ribeiro, Sonia; Gray, Steve; Lucidarme, Jay; Ramsay, Mary; Borrow, Ray; Ladhani, Shamez

doi:10.1016/j.jinf.2019.11.001

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…In addition, there appears to be a shift in IMD prevalence from younger to older people, attributed in part to the success of vaccination programmes against meningitis C in infants and adolescents, but this may also be linked to other factors such as waning immunity amongst those previously vaccinated or immune senescence as a result of aging. Our results are consistent with previous studies which have shown similar trends over time in the epidemiology and clinical presentation of IMD; for example, the link between atypical clinical presentation and higher CFRs [ 23 , 47 , 59 , 78 , 89 ]. A recent meta analysis of the CFR for laboratory-confirmed IMD cases reported a CFR of 9.0% in infants, which gradually decreased to 7.0% in 7-year olds, subsequently increased to 15.0% in young adults (aged < 28 years), stabilised between 15 and 20% in mid-aged adults and reached a high in older adults [ 90 ].…”

Section: Discussionsupporting

confidence: 93%

“…A three-fold increase in the incidence of IMD caused by serogroup W was observed between 2013 and 2017, primarily because of increased cases in children aged < 5 years and adults aged ≥ 50 years. This increase in the incidence of IMD caused by serogroup W was confirmed by national institutions such as the Institut Pasteur [ 87 ] and many studies in European countries including those from the UK [ 42 , 46 , 47 ], Spain [ 48 ], Italy [ 49 ], the Netherlands [ 50 , 51 ], and Sweden [ 44 , 52 ]. One study in Ireland found serogroup Y as the predominant strain in those aged ≥ 65 years [ 53 ].…”

Section: Resultsmentioning

confidence: 73%

“…Meningitis was diagnosed in 33% and pneumonia in 19% of all patients Lab confirmed Two distinct age groups, 11–20 years and > 60 years, together represented the majority of cases (73% of all patients). This age distribution reflects the change in meningococcal epidemiology in Sweden where IMD now largely affects the elderly, with serogroup Y predominating Folaranmi et al 2017 [ 45 ] Evaluation of data from January 2012-June 2015 USA Incidence of MSM in the USA Meningococcal disease data from the National Notifiable Disease Surveillance System Within the oldest age group (56–64 years) there was just 1 case out of a total of 527 total cases Serology Edge et al 2016 [ 46 ] 2007–2011 UK IMD cases confirmed by PHE were linked with national hospital records and death registries Clinical presentation by interrogation of ICD-10 codes Atypical clinical presentations, including pneumonia and septic arthritis, mainly occurred among those aged ≥ 65 years, caused mainly by serogroups W and Y Campbell et al 2020 [ 47 ] 2014 UK 340 laboratory-confirmed IMD cases caused by serogroups: B (179 cases), W (95 cases) and Y (66 cases) in individuals aged ≥ 5 years There were 184 (54%) cases confirmed by culture only, 110 (32%) by PCR only and 46 (14%) by both methods CFR varied by serogroup and increased with age group, but no significant associations were identified in the multivariable logistic regression models. However, older adults and those with serogroup Y disease were significantly and independently more likely to develop meningococcal pneumonia Ortiz de Zárate et al 2016 [ 48 ] 1995–2014 Spain 675 invasive N. meningitidis isolates were analysed during the study period Lab confirmed isolates Serogroup Y isolates were the most frequent among the elderly aged ≥ 65 years Parisi et al 2019 [ 49 ] 2011–2017 Italy IMDs surveillance data from the Italian National Health Institute Presumably notified cases but not explicitly stated …”

Section: Resultsmentioning

confidence: 99%

“…These case studies highlight the need to be aware of the potential for atypical clinical presentation, to ensure early recognition and treatment and to also allow for susceptibility testing and avoidance of inappropriate antibiotic use and treatment failure. Atypical IMD presentation may be more common in older adults, possibly resulting in delayed diagnosis [ 47 , 78 ]. In addition, CFRs tended to be higher in those with underlying medical conditions or atypical clinical presentation [ 27 , 57 , 63 , 80 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

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Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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Background Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. Methods A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. Results There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. Conclusions The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

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Section: Discussionsupporting

confidence: 93%

Section: Resultsmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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“…MenACWY vaccination in adolescence has the added benefit of a broader protection against other serogroups, including MenW, especially due to its transient upsurge in incidence in several countries. Moreover, the increasing proportions of atypical clinical presentation observed for MenW-IMD (gastrointestinal or upper respiratory tract symptoms) may delay rapid diagnosis and management, thus making prevention by vaccination an even more crucial strategy [64,65]. An increasing number of European State-funded MenB vaccination in both infants and adolescents is to date implemented only in South Australia.…”

Section: Discussionmentioning

confidence: 99%

Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations

Martinón-Torres

Taha

Knuf³

et al. 2021

Pathogens and Global Health

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Invasive meningococcal disease (IMD) is a life-threatening, unpredictable condition. Vaccines are available against 5 of the 6 meningococcal serogroups (Men) accounting for nearly all IMD cases worldwide; conjugate monovalent MenC, quadrivalent MenACWY, and protein-based MenB vaccines are commonly used. We provide a comprehensive overview of the evolution of meningococcal vaccination strategies employed in national immunization programmes (NIPs) and their impact on IMD incidence in Europe. A more in-depth description is given for several countries: the United Kingdom (UK), the Netherlands, Greece, Italy, and Ireland. We searched European health authorities' websites and PubMed. Various vaccines and immunization schedules are used in 21 NIPs. Most countries implement MenC vaccination in infants, MenACWY in adolescents, and a growing number, MenB in infants. Only Malta has introduced MenACWY vaccination in infants, and several countries reimburse immunization of toddlers. The UK, Italy, Ireland, Malta, Andorra, and San Marino recommend MenB vaccination in infants and MenACWY vaccination in adolescents, targeting the most prevalent serogroups in the most impacted age groups. Main factors determining new vaccination strategies are fluctuating IMD epidemiology, ease of vaccine implementation, ability to induce herd protection, favorable benefit-risk balance, and acceptable cost-effectiveness. Since 1999, when the UK introduced MenC vaccination, the reduction in IMD incidence has been gradually enhanced as other countries adopted routine meningococcal vaccinations. Meningococcal vaccination strategies in each country are continually adapted to regional epidemiology and national healthcare priorities. Future strategies may include broader coverage vaccines when available (e.g., MenABCWY, MenACWY), depending on prevailing epidemiology.

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Range of Clinical Manifestations Caused by Invasive Meningococcal Disease Due to Serogroup W: A Systematic Review

Bertrand-Gerentes,

Fanchon,

Coste

et al. 2023

Infect Dis Ther

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Introduction Invasive meningococcal disease (IMD) due to serogroup W meningococci (MenW) is consistently reported with atypical clinical manifestations, including gastrointestinal symptoms, bacteremic pneumonia, and septic arthritis. We undertook a systematic review of the literature for a comprehensive assessment of the clinical presentation of IMD caused by MenW. Methods PubMed and Embase databases were searched from inception to June 2022 using a combination of MeSH terms and free text for articles that reported symptoms and signs of MenW IMD, and associated manifestations. Results The most commonly reported symptoms identified included: fever (range 36–100% of cases), nausea and/or vomiting (range 38–47%), vomiting (range 14–68%), cough (range 7–57%), sore throat (range 13–34%), headache (range 7–50%), diarrhea (range 8–47%), altered consciousness/mental status (range 7–38%), stiff neck (range 7–54%), and nausea (range 7–20%). Sepsis (range 15–83% of cases) was the most commonly reported manifestation followed by meningitis (range 5–72%), sepsis and meningitis (range 6–74%), bacteremic pneumonia (range 4–24%), arthritis (range 1–15%), and other manifestations (e.g., pharyngitis/epiglottitis/supraglottitis/tonsillitis/conjunctivitis; range 1–24%). The case fatality rates ranged from 8–40%, and among the survivors 4–14% had long-term sequelae. Conclusions Clinicians need to be aware of the nonspecific symptoms and signs of IMD, as well as of the atypical manifestations in regions where MenW is known to circulate to ensure timely diagnoses and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00869-z.

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Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

Cited by 14 publications

References 27 publications

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations

Range of Clinical Manifestations Caused by Invasive Meningococcal Disease Due to Serogroup W: A Systematic Review

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