Meningococcal carriage in high-risk settings: A systematic review

Peterson, Meagan E; Mile, Rebecca; Li, You; Nair, Harish; Kyaw, Moe H.

doi:10.1016/j.ijid.2018.05.022

Cited by 39 publications

(40 citation statements)

References 49 publications

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“…84,85 Since the inclusion of the quadrivalent meningococcal vaccine in 2001, 85 no major meningo coccal meningitis outbreaks related to hajj have been identified. [85][86][87] However, concern that new serogroups of N meningitidis (eg, B and X), which are not covered in the current quadrivalent vaccine targeting serogroups A, C, W135, and Y, could be a cause of future epidemics is increasing. 88,89 Owing to the high incidence of pertussis seen among Hajj pilgrims in 2003, 90 Bordetella pertussis is considered a risk in pilgrims, especially those who have not completed their immuni sation schedule.…”

Section: Infectious Diseases At the Hajjmentioning

confidence: 99%

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Memish

Steffen

White³

et al. 2019

The Lancet

234

184

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Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibioticresistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreakprone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed. Search strategy and selection criteriaWe searched PubMed, Embase, Cochrane Library, and Google Scholar for English language papers that were published from a.zumla@ucl.ac.uk disorders. Priorities for further investments and oppor tunities for research into prevention, surveillance, and management of communicable and noncom municable diseases, thermal disorders, and mass casualty incidents are discussed.

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Section: Infectious Diseases At the Hajjmentioning

confidence: 99%

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Memish

Steffen

White³

et al. 2019

The Lancet

234

184

View full text Add to dashboard Cite

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“…Conjugate vaccines are more effective in controlling the carriage of meningococci [29,30] but are considerably more expensive. Meningococcal serogroups that are not covered by the current quadrivalent vaccine were frequently isolated from throat swabs collected from pilgrims, namely, serogroups B and, less frequently, X [31][32][33]. A recent systematic review concluded that serogroup B dominated the carriage acquisition among Hajj pilgrims [32], and most carriers received the polysaccharide vaccine, which is not expected to reduce the carriage acquisition of serogroups contained in the vaccine [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Meningococcal serogroups that are not covered by the current quadrivalent vaccine were frequently isolated from throat swabs collected from pilgrims, namely, serogroups B and, less frequently, X [31][32][33]. A recent systematic review concluded that serogroup B dominated the carriage acquisition among Hajj pilgrims [32], and most carriers received the polysaccharide vaccine, which is not expected to reduce the carriage acquisition of serogroups contained in the vaccine [34,35]. The opportunity to prevent future outbreaks depends on an ongoing review of the current mandatory vaccination policy in view of these and future developments.…”

Section: Discussionmentioning

confidence: 99%

Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers

et al. 2019

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Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017-2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3-3.8, p < 0.01; and OR = 1.7, CI = 1-2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9-5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy-practice gap among domestic pilgrims. Author Contributions: Conceptualization, G.R.B., T.A., H.A., and H.R.; data curation, A.-M.B.; formal analysis, A.-M.B. and H.R.; project administration, H.R.; supervision, A.K., R.B., and H.R.; validation, A.-M.B., F.A., W.F., Trop. Med. Infect. Dis. 2019, 4, 127 11 of 13 and A.A.; visualization, A.-M.B.; writing-original draft, A.-M.B., F.A., W.F., A.A., and A.K.; writing-review and editing

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“…The highest carriage prevalence has been reported in populations in semiclosed settings or with extensive close contact, such as universities (6)(7)(8) and military barracks (9,10). Studies have shown that meningococcal carriage is highly dynamic and may be chronic, intermittent, or transient (11)(12)(13)(14)(15).…”

mentioning

confidence: 99%

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

Joseph¹,

Topaz

Chang³

et al. 2020

mSphere

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In 2015 and 2016, meningococcal carriage evaluations were conducted at two universities in the United States following mass vaccination campaigns in response to Neisseria meningitidis serogroup B (NmB) disease outbreaks. A simultaneous carriage evaluation was also conducted at a university near one of the outbreaks, where no NmB cases were reported and no mass vaccination occurred. A total of ten cross-sectional carriage evaluation rounds were conducted, resulting in 1,514 meningococcal carriage isolates collected from 7,001 unique participants; 1,587 individuals were swabbed at multiple time points (repeat participants). All isolates underwent whole-genome sequencing. The most frequently observed clonal complexes (CC) were CC198 (27.3%), followed by CC1157 (17.4%), CC41/44 (9.8%), CC35 (7.4%), and CC32 (5.6%). Phylogenetic analysis identified carriage isolates that were highly similar to the NmB outbreak strains; comparative genomics between these outbreak and carriage isolates revealed genetic changes in virulence genes. Among repeat participants, 348 individuals carried meningococcal bacteria during at least one carriage evaluation round; 50.3% retained N. meningitidis carriage of a strain with the same sequence type (ST) and CC across rounds, 44.3% only carried N. meningitidis in one round, and 5.4% acquired a new N. meningitidis strain between rounds. Recombination, point mutations, deletions, and simple sequence repeats were the most frequent genetic mechanisms found in isolates collected from hosts carrying a strain of the same ST and CC across rounds. Our findings provide insight on the dynamics of meningococcal carriage among a population that is at higher risk for invasive meningococcal disease than the general population. IMPORTANCE U.S. university students are at a higher risk of invasive meningococcal disease than the general population. The responsible pathogen, Neisseria meningitidis, can be carried asymptomatically in the oropharynx; the dynamics of meningococcal carriage and the genetic features that distinguish carriage versus disease states are not completely understood. Through our analyses, we aimed to provide data to address these topics. We whole-genome sequenced 1,514 meningococcal carriage isolates from individuals at three U.S. universities, two of which underwent mass vaccination campaigns following recent meningococcal outbreaks. We describe the within-host genetic changes among individuals carrying a strain with the same molecular type over time, the primary strains being carried in this population, and the genetic differences between closely related outbreak and carriage strains. Our results provide detailed information on the dynamics of meningococcal carriage and the genetic differences in carriage and outbreak strains, which can inform future efforts to reduce the incidence of invasive meningococcal disease.

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Meningococcal carriage in high-risk settings: A systematic review

Cited by 39 publications

References 49 publications

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers

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

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