Meningococcal carriage among a university student population – United States, 2015

Abstract

Objectives Several outbreaks of serogroup B meningococcal disease have occurred among university students in recent years. In the setting of high coverage of the quadrivalent meningococcal conjugate vaccine and prior to widespread use of serogroup B meningococcal vaccines among adolescents, we conducted surveys to characterize the prevalence and molecular characteristics of meningococcal carriage among university students. Methods Two cross-sectional oropharyngeal carriage surveys were conducted among undergraduates at a Rhode Island university. Isolates were characterized using slide agglutination, real-time polymerase chain reaction (rt-PCR), and whole genome sequencing. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression to determine risk factors for carriage. Results A total of 1837 oropharyngeal specimens were obtained from 1478 unique participants. Overall carriage prevalence was 12.7–14.6% during the two survey rounds, with 1.8–2.6% for capsular genotype B, 0.9–1.0% for capsular genotypes C, W, or Y, and 9.9–10.8% for nongroupable strains by rt-PCR. Meningococcal carriage was associated with being male, smoking, party or club attendance, recent antibiotic use (inverse correlation), and recent respiratory infections. Conclusions In this university setting, the majority of meningococcal carriage was due to nongroupable strains, followed by serogroup B. Further evaluation is needed to understand the dynamics of serogroup B carriage and disease among university students.

B Part of It study: a longitudinal study to assess carriage of Neisseria meningitidis in first year university students in South Australia

“…The numbers of adolescents smoking was lower than rates reported in a 2016 annual survey for 15 to 29 year olds in South Australia of 10.5% (95% CI, 7.8% to 13.2%), 18 and lower than other recent carriage studies in similar age groups. 2,19,20 Some carriage studies have reported a sharp increase in the prevalence of pharyngeal N. meningitidis during the first year Table 2. Proportion of Neisseria meningitidis pharyngeal carriage from oropharyngeal swab, at visit 1 (participants who were lost to follow up), visit 1 (returned for follow up swab), and combined total.…”

“…Associations with carriage at visit 1 reflected those reported previously in overseas studies, with attending one or more parties or bars in the last week, and kissing one or more persons in the last week both independently associated with carriage. 2,19,20,23 Of note, students that went out more than once a week and kissed one or more people had a carriage prevalence of 25%. The low numbers of participants who smoked, used e-cigarettes, or water pipes meant that little can be elucidated from these potential risk factors in this cohort.…”

Meningococcal carriage in high-risk settings: A systematic review

“…Fifteen studies that sampled only university students met the inclusion criteria. Six studies were cross-sectional studies (Aliyu and Olayinka, 2017;Bali et al, 2017;Rizek et al, 2016;Rodrigues et al, 2015;Rodriguez et al, 2014;Tryfinopoulou et al, 2016;Takahashi et al, 2016), six were repeat cross-sectional studies with a nested cohort (either intentional or unintentional) (Ala'aldeen et al, 2011;Breakwell et al, 2018;Durey et al, 2012;McNamara et al, 2017b;Oldfield et al, 2017;Soeters et al, 2017), two were cohort studies (Bidmos et al, 2011;Gilca et al, 2013), and one was a randomized controlled trial investigating the impact of vaccination on carriage (Read et al, 2014). The majority of studies were conducted in the region of the Americas (n = 6) or the European region (n = 6), and no study was identified from the Eastern Mediterranean region.…”

Insights on Population Structure and Within-Host Genetic Changes among Meningococcal Carriage Isolates from U.S. Universities

“…Data collection. From February 2015 to March 2016, a total of ten rounds of cross-sectional carriage surveys were conducted at three U.S. universities (RI-1, RI-2, an OR) using standardized methods, as previously described (6,21,22) Fig. S1 in the supplemental material).…”

“…Additional work is under way to analyze the possible impact of mass vaccination on the carriage and acquisition of strains potentially covered by the vaccine, and this work will be published at a later date. A third carriage evaluation was conducted at another university in Rhode Island (RI-2), where no IMD outbreak or cases were reported (22) and no mass vaccination occurred. We sequenced isolates from these three carriage evaluations in order to describe within-host genetic changes in individuals carrying N. meningitidis at multiple time points, elucidate the meningococcal carriage population structure, and compare closely related carriage and outbreak isolates.…”