Interconnected clusters of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11), involving bisexuals and men who have sex with men, with discos and gay-venues hotspots of transmission, Tuscany, Italy, 2015 to 2016

Abstract

In 2015 an increased incidence of invasive meningococcal disease due to serogroup-C (MenC) occurred in Tuscany, Italy. This led the Regional Health Authority of Tuscany to implement a reactive immunisation campaign and to launch an epidemiological field investigation aiming to address targeted immunisation interventions. In 2011–14, 10 MenC cases had been reported compared with 62 cases in 2015–16. The case fatality rate was 21% (n = 13) and 51 cases (82.3%) were confirmed as C:P1.5–1,10–8:F3–6:ST-11(cc11). Overall, 17 clusters were recognised. Six discos and four gay-venues were found to have a role as transmission-hotspots, having been attended by 20 and 14 cases in the 10 days before symptoms onset. Ten and three cases occurred, respectively, among men who have sex with men (MSM) and bisexual individuals, who were involved in 11 clusters. In addition, heterosexual cases (n = 5) attending gay-venues were also found. Secondary cases were not identified. Molecular typing indicated close relationship with MenC clusters recently described among gay, bisexual and other MSM in Europe and the United States, suggesting a possible international spread of the serogroup-C-variant P1.5–1,10–8:F3–6:ST-11(cc11) in this population-group; however, epidemiological links were not identified. In December 2016, a targeted vaccination campaign involving discos and lesbian, gay, bisexual, and transgender (LGBT) associations was implemented. During 2017, 10 cases of MenC occurred, compared with 32 and 30 cases reported in 2015 and 2016 respectively, suggesting the effectiveness of the reactive and targeted immunisation programmes.

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

“…The US_NmUC strain emerged around the year 2011 and forms part of a broader, predominantly serogroup C strain (PorA subtype P1.5-1,10-8: ST-11 complex) that, as well as causing invasive disease within the general community, has caused multiple outbreaks of serogroup C invasive disease among MSM in Europe and North America [8][9][10]. Phylogenetically, the isolates responsible for community cases and MSM outbreaks were broadly interspersed [11], however, discrete The US US_NmUC isolates [1] formed two sub-strains.…”

Engaging adolescents in developing health education interventions: a multidisciplinary pilot project

“…In line with these findings, participants considered social media as unreliable, with particular relevance for MM. This was probably due to a recent disease outbreak that occurred in Tuscany in 2015–17 10 that led to anxiety among the residents and stepped up demand for vaccination.…”

Reconstruction of Dispersal Patterns of Hypervirulent Meningococcal Strains of Serogroup C:cc11 by Phylogenomic Time Trees

“…The combination of epidemiological investigation with phylogenetic analyses allowed the identification of clusters and confirmation of possible transmission links among IMD cases. In particular, cases belonging to the same statistically supported clusters shared the same contact locations and/or risk factors, such as, for example, close contact with men who have sex with men (MSM) (e.g., cases who had two MSM family members with a sexual relationship) (10). Several studies have reported outbreaks of serogroup C meningococci associated with attendance at social venues of high transmission risk such as discos/gay venues (31)(32)(33)(34)(35).…”

“…During the period from 2010 to 2015, all the Italian regions showed stable low incidence of IMD, with the exception of the Tuscany region, where an increase of cases due to MenC was reported starting in the year 2015 (9). The outbreak lasted for 2 years, in 2015 and 2016, causing a total of 62 cases of IMD, and was attributable to MenC strains belonging to the hypervirulent cc11 complex, with the finetype C:P1.5-1,10-8:F3-6:ST-11(cc11), which underwent a clonal expansion in the area (10). In Italy, clusters due to this MenC strain had previously been described in 2008 and in 2012 (11,12); however, none of these caused a large epidemic event with sustained transmission, such as the outbreak that occurred in Tuscany in 2015 to 2016.…”