Clonal Distribution of Invasive Neisseria meningitidis Serogroup C Strains Circulating from 1976 to 2005 in Greater São Paulo, Brazil

Abstract

Meningococcal disease is characterized by cyclic fluctuations in incidence, serogroup distribution, and antigenic profiles. In greater São Paulo, Brazil, there has been a constant increase in the incidence of serogroup C meningococcal disease since the late 1980s. To gain an understanding of changes in serogroup C meningococcal disease over three decades in greater São Paulo, Brazil, 1,059 invasive Neisseria meningitidis serogroup C isolates from 1976 and 2005 were analyzed. Three major clone complexes, sequence type (ST)-11, ST-8, and ST-103, were identified by multilocus sequence typing, and the isolates were characterized by serotyping and 16S rRNA typing. During the 30-year period, there were two major antigenic replacements: from 2a:P1.(5,2) to 2b:P1.3 and subsequently to 23:P1.14-6. All strains of clone ST-103 were characterized as serotype 23 and serosubtype P1.14-6. The origin of 23:P1.14-6 ST-103 complex strains is unknown, but efforts are needed to monitor its spread and define its virulence. The antigenic replacements we observed likely represent a mechanism to sustain meningococcal disease in the population as immunity to circulating strains accumulated.

Significance of Meningococcal Hyperinvasive Clonal Complexes and Their Influence on Vaccines Development

“…in educational institutions, military barracks, or other crowded, semi-closed places. (Bijlsma et al, 2014;Brehony et al, 2007;Chacon-Cruz et al, 2014;Deghmane et al, 2010;de Lemos et al, 2007;ECDC, 2013;Fazio et al, 2009;Garnier et al, 2011;Simon et al, 2013). Also in Poland between 2006-2009 several outbreaks were recorded as well as an increase of incidence of MenC ST-11CC (Fig.…”

High prevalence of Neisseria meningitidis hypervirulent lineages and emergence of W135:P1.5,2:ST-11 clone in Southern Brazil

“…These were previously found in other states of Brazil, but not in RS. 2,24,25 These hypervirulent clones have been reported to cause outbreaks and epidemics worldwide, reinforcing the importance of molecular characterization of MD cases in order to monitor the spread of these lineages and to establish control measures for the disease. 26e28 There was a higher genetic diversity in isolates within the ST-32 complex than was seen between 1995 and 2003, with 18 different STs, 8 of them novel.…”

“…Serogroup C:P1.14-6 was the most prevalent serosubtype in greater São Paulo in a study reporting an increase of this phenotype in the last few years. 25 Sequencing of some of these isolates from São Paulo revealed that they have the genotype P1.22,14-6 (A.P. Lemos, personal communication), the same as RS strains.…”

Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil

“…31,53 In Rio de Janeiro, the cluster A4 epidemic strains often express sero-subtype 2b:P1.10 ( Figure 3), which has caused epidemic and hiperendemic waves of disease in other parts of Brazil but expressing an unusual subtype, P1.3. 2,11,12 Serogroup C disease has emerged in the Rio de Janeiro metropolitan area once more after the year 2000, and now it represents more than 90% of the clinical isolates ( Figure 1). The strains have mainly been associated with the phenotypes C:23:P1.14-6, C:4,7:P1.19,15, P1.7.…”

“…1 The epidemic strain was characterized as phenotype 2a:P1.5, 1.2 genetically related to the ET-37 complex. 2 In the 1980s, 1408 cases of meningococcal disease were reported, with incidence of 1-5 cases/\100,000/\ year (Rio de Janeiro City Health Department). Since 1985, a steady increase of serogroup B clinical isolates was observed, initially attributed to an improvement in the laboratory diagnostic procedures in identifying meningeal pathogens ( Figure 1).…”