Meningococcal serogroups and surveillance: a systematic review and survey

Abstract

BackgroundMeningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use.MethodsWe conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods.ResultsWe included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks.ConclusionsDue to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.

Carriage of Neisseria Meningitidis in Low and Middle Income Countries of the Americas and Asia: A Review of the Literature

“…A recently published systematic review and meta-analysis by Peterson and colleagues investigated serogroup-specific meningococcal carriage by age group [66]. Eligible carriage studies were carried out between 2007 and 2016 in healthy populations with defined age groups and geographical regions.…”

“…In this region, carriage is highest in children, although patterns are not always consistent among studies [67]. In the systematic review by Peterson and colleagues, carriage in sub-Saharan Africa ranged from 1.7% in Burkina Faso (individuals aged 1-29 years) to 13.2% in the Gambia (individuals aged 10-18 years) [66]. In a metaanalysis of six of these African studies, the pattern of carriage across age groups was similar for all serogroups, with a peak consistently observed in 5-17 year olds.…”

“…One particular limitation of this search strategy is that the current review includes two studies from China with only one including data outside of an outbreak setting [51,53]. In contrast, the recently published systematic review of meningococcal carriage by Peterson and colleagues described above [66], which searched several databases (e.g., global health and Chinese literature databases), did not exclude any article based on language, and therefore included 29 studies from China (all of which were conducted between 2007 and 2016). However, compared with our literature review, this systematic review did not assess risk factors for carriage nor did it limit the analysis to low or middle income countries.…”

Clinical cases of meningococcal infection caused by Neisseria meningitidis serogroup W

“…В настоящее время в структуре заболеваемости менингококковой инфекцией доля менингококка серогруппы W увеличилась до 10-50% в странах Африки и Латинской Америки, в странах Европы до 32%, в Российской Федерации более чем на 30% [7,[16][17][18][19][20][21][22][23][24][25][26]. Необходимо отметить, что в последние годы наибольшую актуальность приобретает изучение клинических особенностей менингококковой инфекции в зависимости от серогруппы менингококка.…”

Comparative genomic analyses of Chinese serogroup W ST-11 complex Neisseria meningitidis isolates

“…Serogroups A, B, C, W, X and Y cause almost all cases of invasive meningococcal disease (IMD). 1,2 Vaccination using serogroup-specific polysaccharide or conjugate vaccines is the most effective means of prevention of IMD. Different serogroup distributions across different countries have led to different vaccination programmes and strategies.…”