Invasive Meningococcal Disease Remains a Health Threat in Vietnam People’s Army

Abstract

Objective Despite strict surveillance, Neisseria meningitidis still causes life-threatening invasive meningococcal disease (IMD). The study aimed to describe the prevalence, clinical and subclinical features, and treatment outcomes of IMD among young soldiers of the Vietnam People’s Army. Methods A prospective, population-based surveillance study was conducted in all Vietnamese military hospitals from January 2014 to June 2021. The presence of Neisseria meningitidis was confirmed by PCR or culture from blood or/and CSF. Epidemiological indices (incidence, serogroups, and distribution of cases by length of service), medical history, clinical and sub-clinical features, and treatment outcomes were documented and analyzed. Results There were 69 IMD cases (91% serogroup B) documented, mainly in conscripts (91%). The highest annual incidence was 3.33/100,000 soldiers per year. Of these cases, 44% were meningitis (n=30), 19% septicemia (n=13), and 38% meningococcemia (n=26). The most common clinical symptoms were neck stiffness (61 cases, 88%), petechial rash (51%), and shock (20 cases, 29%). Laboratory findings showed leukocytosis in 96% of IMD cases, PCT >0.05 (ng/mL) in 100%, elevated leukocyte count (>1,000/mm3) in 71%, and high protein >1 g/L in 70%. The overall mortality rate was 9%. Two cases were found to be resistant to ceftriaxone. Prognostic factors of severity included petechial rash (OR = 9.82, p < 0.001), septicemia (OR = 5.83, p < 0.001), meningococcemia (OR = 6.22, p < 0.001), low platelet count, prolonged prothrombin time; high PCT (AUC = 0.84, p < 0.001), and increased creatinine (AUC = 0.86, p < 0.001). Conclusion IMD remains a health threat in the armed forces in Vietnam, especially among new recruits. To the best of our knowledge, this is the first study in Vietnam describing ceftriaxone resistance in Neisseria meningitidis and suggests the need to reconsider standard empiric therapy for IMD.

Uncommon Presentation of Meningococcal Pneumonia in Vietnam: A Case Report

“…Meningococcal pneumonia is an uncommon manifestation of the meningococcal infection [1,2], which has not been documented in Vietnam to date [3]. Unlike typical presentations of meningococcal infection that result in meningitis and septicemia [1,2,4], this case highlights the emergence of pneumonia as the sole clinical manifestation.…”

Invasive meningococcal disease in Malaysia, Philippines, Thailand, and Vietnam: An Asia-Pacific expert group perspective on current epidemiology and vaccination policies

“… 42 In Hanoi, reported incidence rates for children under the age of five years varied from 2.6 to 7.4 per 100,000. 42 , 43 Reported CFRs are also high, ranging from 8.7% 41 to 34.7%. 39…”

“…37 In 2018, the incidence rate was 0.02 per 100,000 population. 40 High incidence rates have been recorded in surveillance studies, ranging from 1.9 per 100,000 among army recruits 41 to 36.2 per 100,000, among newborns aged less than one month in Hanoi. 42 In Hanoi, reported incidence rates for children under the age of five years varied from 2.6 to 7.4 per 100,000.…”

“…44 A prospective, population-based surveillance study conducted in all Vietnamese military hospitals from January 2014 to June 2021 identified 69 IMD cases, of which 91% were MenB. 41 …”

Estimation of the incidence of invasive meningococcal disease using a capture–recapture model based on two independent surveillance systems in Catalonia, Spain

“…Case fatality rate is about 10% in developed countries,4–6 and 40%–65% present with meningitis, but meningococcemia and pneumonia are also frequent,4 being the serogroup involved related both with the case fatality rate7 and the predominant clinical form 8. Serogroup B causes more than a third part of IMD,4 9 but in some countries or population groups the proportion is even higher 10 11. In Spain, from 2009 to 2018, serogroup B accounted for 64% of IMD cases 12.…”