Declining Incidence of Invasive Meningococcal Disease in South Africa: 2003–2016

Abstract Background Invasive meningococcal disease (IMD) is endemic to South Africa, where vaccine use is negligible. We describe the epidemiology of IMD in South Africa. Methods IMD cases were identified through a national, laboratory-based surveillance program, GERMS-SA, from 2003–2016. Clinical data on outcomes and human immunodeficiency virus (HIV) statuses were available from 26 sentinel hospital sites. We conducted space-time analyses to detect clusters of serogroup-specific IMD cases. Results Over 14 years, 5249 IMD cases were identified. The incidence was 0.97 cases per 100 000 persons in 2003, peaked at 1.4 cases per 100 000 persons in 2006, and declined to 0.23 cases per 100 000 persons in 2016. Serogroups were confirmed in 3917 (75%) cases: serogroup A was present in 4.7% of cases, B in 23.3%, C in 9.4%; W in 49.5%; Y in 12.3%, X in 0.3%; Z in 0.1% and 0.4% of cases were non-groupable. We identified 8 serogroup-specific, geo-temporal clusters of disease. Isolate susceptibility was 100% to ceftriaxone, 95% to penicillin, and 99.9% to ciprofloxacin. The in-hospital case-fatality rate was 17% (247/1479). Of those tested, 36% (337/947) of IMD cases were HIV-coinfected. The IMD incidence in HIV-infected persons was higher for all age categories, with an age-adjusted relative risk ratio (aRRR) of 2.5 (95% confidence interval [CI] 2.2–2.8; P < .001) from 2012–2016. No patients reported previous meningococcal vaccine exposure. Patients with serogroup W were 3 times more likely to present with severe disease than those with serogroup B (aRRR 2.7, 95% CI 1.1–6.3); HIV coinfection was twice as common with W and Y diseases (aRRR W = 1.8, 95% CI 1.1–2.9; aRRR Y = 1.9, 95% CI 1.0–3.4). Conclusions In the absence of significant vaccine use, IMD in South Africa decreased by 76% from 2003–2016. HIV was associated with an increased risk of IMD, especially for serogroup W and Y diseases.

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Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population

BMJ Open ◽

10.1136/bmjopen-2021-049967 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049967

Author(s):

Karen Sól Saevarsdóttir ◽

Hildur Ýr Hilmarsdóttir ◽

Ingibjörg Magnúsdóttir ◽

Arna Hauksdóttir ◽

Edda Bjork Thordardottir ◽

...

Keyword(s):

Severe Disease ◽

Symptom Burden ◽

Cross Sectional Study ◽

Illness Severity ◽

University Education ◽

Adjusted Relative Risk ◽

Sectional Study ◽

Cross Sectional ◽

Symptoms Of Depression ◽

Increased Risk

ObjectiveTo test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

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Maternal mild thyroid dysfunction and offspring cognitive and motor development from infancy to childhood: the Rhea mother–child cohort study in Crete, Greece

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213309 ◽

2020 ◽

pp. jech-2019-213309

Author(s):

Mariza Kampouri ◽

Katerina Margetaki ◽

Katerina Koutra ◽

Andriani Kyriklaki ◽

Polyxeni Karakosta ◽

...

Keyword(s):

Cognitive Development ◽

Motor Development ◽

Thyroid Dysfunction ◽

Thyroid Autoimmunity ◽

Relative Risk Ratio ◽

Thyroid Peroxidase ◽

Adjusted Relative Risk ◽

Motor Ability ◽

Increased Risk ◽

Maternal Thyroid

BackgroundMaternal thyroid hormones’ supply is crucial for fetal neurodevelopment; however, the role of maternal mild thyroid dysfunction is not clear. We aimed to assess the association of maternal mild thyroid dysfunction with child neuropsychological development from infancy to early childhood.MethodsWe included 757 mother–child pairs from the prospective ‘Rhea’ cohort on Crete, Greece. Maternal thyroid functioning was assessed by quantitative analysis of serum thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibodies and thyroglobulin antibodies at early gestation (mean=14 weeks). Neuropsychological assessment was based on Bayley Scales of Infant Development (18 months of age), McCarthy Scales of Children’s Abilities (4 years of age), Raven’s Coloured Progressive Matrices, Trail Making Test and Finger Tapping Test (6 years of age).ResultsIn multivariate adjusted linear regression analyses, maternal hypothyroxinemia was associated with decreased verbal scores at 4 years and reduced motor speed at 6 years of age. Maternal thyroid autoimmunity was associated with decreased child perceptual and motor ability at 4 years of age. Four trajectories of longitudinal non-verbal cognitive development were identified and children exposed to maternal thyroid autoimmunity had increased risk for belonging to an adverse trajectory (‘low’: adjusted relative risk ratio (RRR) = 2.7 95% CI: (1.4, 5.2), ‘high-decreasing’: adjusted RRR = 2.2 95% CI: (1.2, 4.0), ‘low-increasing’: adjusted RRR = 1.8 95% CI: (1.0, 3.2)).ConclusionMaternal hypothyroxinemia is associated with reduced offspring verbal and motor ability. Maternal thyroid autoimmunity is associated with decreased offspring perceptual performance and motor ability and increased risk for adverse non-verbal cognitive development from infancy to childhood.

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Usefulness of Pulsed-Field Gel Electrophoresis in Tracking Two Outbreaks of Invasive Meningococcal Disease Serogroup C in British Columbia

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2007/295973 ◽

2007 ◽

Vol 18 (6) ◽

pp. 363-367 ◽

Cited By ~ 3

Author(s):

Grahame Quan ◽

Mark Gilbert ◽

Samara T David ◽

Tazim Rahim ◽

Kathy Adie ◽

...

Keyword(s):

British Columbia ◽

Meningococcal Disease ◽

Gel Electrophoresis ◽

Outer Membrane Proteins ◽

Case Fatality ◽

Pulsed Field Gel Electrophoresis ◽

Invasive Meningococcal Disease ◽

Sequencing Data ◽

Outbreak Strain ◽

Pulsed Field

Two major outbreaks of invasive meningococcal disease serogroup C (IMD-C) were identified in British Columbia between 2000 and 2004. Pulsed-field gel electrophoresis (PFGE) andporAgene sequencing of all retained IMD-C isolates were used to assess correlations between genotypes and epidemiological patterns. PFGE patterns of IMD-C genotypes correlated with epidemiological patterns between 2000 and 2004 in British Columbia, and demonstrated that PFGE can identify outbreak-related cases. Both IMD-C outbreaks correlated with a respective PFGE pattern. PFGE analysis demonstrated that the 2004 British Columbia outbreak strain in men who have sex with men was closely related to the 2001 Abbotsford outbreak strain.PorAsequencing data indicated low diversity of class 1 outer membrane proteins in British Columbia, and did not correlate with epidemiological trends. There was a trend for outbreak-associated PFGE types to demonstrate higher case fatality rates.

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Invasive meningococcal disease among university undergraduates: association with universities providing relatively large amounts of catered hall accommodation

Epidemiology and Infection ◽

10.1017/s0950268899002368 ◽

1999 ◽

Vol 122 (3) ◽

pp. 351-357 ◽

Cited By ~ 36

Author(s):

K. R. NEAL ◽

J. NGUYEN-VAN-TAM ◽

P. MONK ◽

S. J. O'BRIEN ◽

J. STUART ◽

...

Keyword(s):

University Students ◽

Meningococcal Disease ◽

Communicable Disease ◽

Invasive Meningococcal Disease ◽

Increased Risk ◽

Structural Risk ◽

Significant Regression ◽

The Uk ◽

University Undergraduates ◽

Health Districts

The incidence of invasive meningococcal disease (IMD) among UK university students and non-students of similar age was investigated. In addition, we sought to identify structural risk factors associated with high rates of IMD in individual universities. Cases were ascertained via Consultants in Communicable Disease Control (or equivalent officers) between September 1994 and March 1997. Data on individual universities were obtained from university accommodation officers.University students had an increased annual rate of invasive meningococcal disease (13·2/105, 95% CI 11·2–15·2) compared with non-students of similar age in the same health districts (5·5/105, CI 4·7–6·4) and in those health districts without universities (3·7/105, CI 2·9–4·4). This trend was highly significant. Regression analysis demonstrated catered hall accommodation to be the main structural risk factor. Higher rates of disease were observed at universities providing catered hall places for >10% of their student population (15·3/105, CI 11·8–18·8) compared with those providing places for <10% of students (5·9/105, CI 4·1–7·7). The majority of IMD amongst students was caused by serogroup B organisms.University students in the UK are at increased risk of IMD compared with non-students of a similar age. The incidence of IMD tends to be greatest at universities with a high provision of catered hall accommodation.

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Invasive meningococcal disease associated with a very high case fatality rate in the North-West of Poland

FEMS Immunology & Medical Microbiology ◽

10.1111/j.1574-695x.2005.00027.x ◽

2006 ◽

Vol 46 (2) ◽

pp. 230-235 ◽

Cited By ~ 5

Author(s):

Anna SkoczyÅ„ska ◽

Marcin KadÅ‚ubowski ◽

JÃ³zef Knap ◽

Maria Szulc ◽

Marzena Janusz-Jurczyk ◽

...

Keyword(s):

Meningococcal Disease ◽

Case Fatality Rate ◽

Case Fatality ◽

Invasive Meningococcal Disease ◽

Fatality Rate ◽

High Case Fatality Rate ◽

North West ◽

The North ◽

Very High

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Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

10.1101/2020.09.22.20199398 ◽

2020 ◽

Cited By ~ 1

Author(s):

Massimo Fabiani ◽

Alberto Mateo-Urdiales ◽

Xanthi Andrianou ◽

Antonino Bella ◽

Martina Del Manso ◽

...

Keyword(s):

Surveillance System ◽

Negative Binomial ◽

Healthcare Access ◽

Delayed Diagnosis ◽

Case Fatality ◽

Negative Binomial Regression ◽

Adjusted Relative Risk ◽

Risk Of Death ◽

Increased Risk ◽

Epidemiological Characteristics

Background International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers, and refugees. Methods We analysed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case-fatality rate and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. Results We analysed 213,180 COVID-19 cases, including 15,974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalised [(adjusted relative risk (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44)] and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower HDI. We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). Conclusions A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.

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The Clinical Picture and Severity of Invasive Meningococcal Disease Serogroup W Compared With Other Serogroups in the Netherlands, 2015–2018

Clinical Infectious Diseases ◽

10.1093/cid/ciz578 ◽

2019 ◽

Vol 70 (10) ◽

pp. 2036-2044 ◽

Cited By ~ 2

Author(s):

Anna D Loenenbach ◽

Arie van der Ende ◽

Hester E de Melker ◽

Elisabeth A M Sanders ◽

Mirjam J Knol

Keyword(s):

The Netherlands ◽

Meningococcal Disease ◽

Clinical Picture ◽

Disease Onset ◽

Clinical Manifestations ◽

Case Fatality ◽

Invasive Meningococcal Disease ◽

Almost All ◽

Specific Symptoms ◽

Host Characteristics

Abstract Background An increase in invasive meningococcal disease (IMD) serogroup W (IMD-W) cases caused by sequence type-11 clonal complex (cc11) was observed from October 2015 in the Netherlands. We compared the clinical picture and disease outcome of IMD-W cases with other serogroups, adjusting for host characteristics. Methods We included IMD cases reported from January 2015 to June 2018 in the Netherlands and assessed clinical manifestation and symptoms at disease onset and calculated case fatality rates (CFRs). We used logistic regression to compare clinical manifestations and mortality of IMD-W with IMD caused by meningococci serogroup B, Y, or C, adjusting for age, gender, and comorbidities. Results A total of 565 IMD cases were reported, of which 204 were IMD-W, 270 IMD-B, 63 IMD-Y, and 26 IMD-C. Most IMD-W isolates belonged to cc11 (93%; 175/188). Compared with other serogroups, IMD-W patients were diagnosed more often with septicemia (46%) or pneumonia (12%) and less often with meningitis (17%, P < .001). IMD-W cases presented more often with respiratory symptoms (45%, P < .001); 16% of IMD-W patients presented with diarrhea without IMD-specific symptoms (P = .061). The CFR for IMD-W was 16% (32/199, P < .001). The differences between IMD-W and other serogroups remained after adjusting for age, gender, and comorbidities. Conclusions The atypical presentation and severe outcome among IMD-W cases could not be explained by age, gender, and comorbidities. Almost all our IMD-W cases were caused by cc11. More research is needed to identify the bacterial factors involved in clinical presentation and severity of IMD-W cc11.

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Invasive Meningococcal Disease in Africa’s Meningitis Belt: More Than Just Meningitis?

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz251 ◽

2019 ◽

Vol 220 (Supplement_4) ◽

pp. S263-S265 ◽

Cited By ~ 4

Author(s):

Heather E Reese ◽

Olivier Ronveaux ◽

Jason M Mwenda ◽

Andre Bita ◽

Adam L Cohen ◽

...

Keyword(s):

Conjugate Vaccine ◽

Meningococcal Disease ◽

Disease Surveillance ◽

Clinical Presentation ◽

Case Fatality ◽

Clinical Syndrome ◽

Invasive Meningococcal Disease ◽

World Health ◽

Case Fatality Ratio ◽

Meningitis Belt

Abstract Since the progressive introduction of the meningococcal serogroup A conjugate vaccine within Africa’s meningitis belt beginning in 2010, the burden of meningitis due to Neisseria meningitidis serogroup A (NmA) has substantially decreased. Non-A serogroups C/W/X are now the most prevalent. Surveillance within the belt has historically focused on the clinical syndrome of meningitis, the classic presentation for NmA, and may not adequately capture other presentations of invasive meningococcal disease (IMD). The clinical presentation of infection due to serogroups C/W/X includes nonmeningeal IMD, and there is a higher case-fatality ratio associated with these non-A serogroups; however, data on the nonmeningeal IMD burden within the belt are scarce. Expanding surveillance to capture all cases of IMD, in accordance with the World Health Organization’s updated vaccine-preventable disease surveillance standards and in preparation for the anticipated introduction of a multivalent meningococcal conjugate vaccine within Africa’s meningitis belt, will enhance meningococcal disease prevention across the belt.

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Atypical presentation of invasive meningococcal disease caused by serogroup W meningococci

Epidemiology and Infection ◽

10.1017/s0950268819002152 ◽

2020 ◽

Vol 148 ◽

Cited By ~ 2

Author(s):

C. Stinson ◽

C. Burman ◽

J. Presa ◽

M. Abalos

Keyword(s):

Septic Arthritis ◽

Meningococcal Disease ◽

Case Fatality ◽

Signs And Symptoms ◽

Rapid Onset ◽

Invasive Meningococcal Disease ◽

Upper Respiratory Tract ◽

Gi Symptoms ◽

Bacteremic Pneumonia ◽

Atypical Presentations

Abstract Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.

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Sexual practices have a significant impact on the vaginal microbiota of women who have sex with women

Scientific Reports ◽

10.1038/s41598-019-55929-7 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Erica L. Plummer ◽

Lenka A. Vodstrcil ◽

Christopher K. Fairley ◽

Sepehr N. Tabrizi ◽

Suzanne M. Garland ◽

...

Keyword(s):

Bacterial Diversity ◽

Vaginal Microbiota ◽

Gardnerella Vaginalis ◽

Relative Risk Ratio ◽

Rrna Gene ◽

Adjusted Relative Risk ◽

Associated Bacteria ◽

Increased Risk ◽

Curtis Dissimilarity ◽

The Impact

AbstractWomen-who-have-sex-with-women (WSW) are at increased risk of bacterial vaginosis (BV). We investigated the impact of practices and past BV on the vaginal microbiota within a two-year longitudinal cohort of Australian WSW. Self-collected vaginal swabs were used to characterise the vaginal microbiota using 16S-rRNA gene sequencing. Hierarchical clustering defined community state types (CSTs). Bacterial diversity was calculated using the Shannon diversity index and instability of the vaginal microbiota was assessed by change of CST and Bray-Curtis dissimilarity. Sex with a new partner increased the bacterial diversity (adjusted-coefficient = 0.41, 95%CI: 0.21,0.60, p < 0.001) and instability of the vaginal microbiota, in terms of both change of CST (adjusted-odds-ratio = 2.65, 95%CI: 1.34,5.22, p = 0.005) and increased Bray-Curtis dissimilarity (adjusted-coefficient = 0.21, 95%CI: 0.11,0.31, p < 0.001). Women reporting sex with a new partner were more likely than women reporting no new partner to have a vaginal microbiota characterised by Gardnerella vaginalis (adjusted-relative-risk-ratio[aRRR] = 3.45, 95%CI: 1.42,8.41, p = 0.006) or anaerobic BV-associated bacteria (aRRR = 3.62, 95%CI: 1.43,9.14, p = 0.007) relative to a Lactobacillus crispatus dominated microbiota. Sex with a new partner altered the vaginal microbiota of WSW by increasing the diversity and abundance of BV-associated bacteria. These findings highlight the influence of practices on the development of a non-optimal vaginal microbiota and provide microbiological support for the sexual exchange of bacteria between women.

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