Meningococcal Disease in the Netherlands, 1958-1990: A Steady Increase in the Incidence Since 1982 Partially Caused by New Serotypes and Subtypes of Neisseria meningitidis

Abstract

In order to explain a threefold increase in the incidence of meningococcal disease in the Netherlands during the 1980s, we serotyped and subtyped Neisseria meningitidis isolates recovered between 1958 and 1990 from > 3,000 patients with systemic disease. No single strain could be held responsible for the increase. Apart from the newly introduced strain B:4:P1.4, which became the most prevalent phenotype in 1990 (21% of all isolates), the majority of the cases in 1990 were caused by many different strains that were already present in the Netherlands before 1980. For the period 1980-1990, a shift in the age distribution of patients with meningococcal disease from younger to older age categories was found, particularly with regard to cases due to meningococci of serogroup B; this shift is explained by the changing distribution of serotypes and subtypes within serogroup B. A polyvalent group B, class 1 outer-membrane-protein vaccine of a stable composition could theoretically have prevented approximately 80% of all group B meningococcal infections in the Netherlands during the past 30 years.

Sero/subtyping ofNeisseria meningitidisisolated from patients in Spain

“…Only 89 strains (12 %) were non-serotypable, this proportion being lower than that found by other authors in different European countries [5,6,10] case for serogroup C isolates, so new subtype reagents are required for this group of meningococci. More than 50 % of serogroup B meningococci were serotype 4 and almost 50 % of these serotype 4 strains reacted with the P1.…”

“…Serotype and serosubtype reagents have been used in epidemiological studies and some specific types of strains have been associated with epidemic periods [4][5][6].…”

Stability of PorA during a Meningococcal Disease Epidemic

“…The greater population density and the greater diversity of strains in these countries (23,31) than those in New Zealand may have contributed to greater mixing of meningococcal DNA, allowing for the increased variety of PorA types.…”

Clonal Analysis of Neisseria meningitidis Serogroup B Strains in South Africa, 2002 to 2006: Emergence of New Clone ST-4240/6688

“…Globally, six meningococcal serogroups, A, B, C, Y, W135, and, more recently, X, are responsible for most cases of invasive meningococcal disease (27). Neisseria meningitidis serogroup B is a major cause of meningococcal disease in industrialized and developing countries, contributing to at least 30% to 80% of the disease (27,46,50,57). Serogroup B disease occurs mostly as sporadic cases and is endemic to many regions of the world (42,45,48,52,53).…”

“…However, prolonged outbreaks have occurred in Brazil (49), Chile (11), Cuba (51), and Oregon (14). Epidemics can span several years, as in the case of New Zealand (19), Norway (1), and the Netherlands (42,50). In South Africa, serogroups A, B, C, Y, and W135 cause invasive disease (10,37,63).…”