Prolonged outbreak of B meningococcal disease in the Seine-Maritime department, France, January 2003 to June 2005

Abstract

Between January 2003 and June 2005, an outbreak of meningococcal disease occured in the department of Seine-Maritime in northern France. Eighty six cases were notified, giving an average annual incidence of 2.7 cases per 100 000 inhabitants, compared with 1.6 in France. An especially affected area was defined as the city of Dieppe and its surrounding area (26 cases, giving an annual incidence of 12 cases per 100 000). This outbreak was due to N. meningitidis phenotype B:14:P1.7,16 belonging to the clonal complex ST-32/ET-5. Over the 31 B14:P1.7,16 cases confirmed by phenotyping methods at the national reference centre for meningococci (CNR, Centre National de Référence des méningocoques) the case-fatality rate (19%) and the proportion of purpura fulminans (42%) were especially high. Teenagers aged between 15 and 19 years and children aged 1 to 9 years were the most affected. In 2003, health authorities put in place enhanced epidemiological surveillance and informed practitioners and population about the disease. In 2004, the national vaccination advisory board studied the opportunity of using a non licensed outer membrane vesicle vaccine developed in Norway which may be effective against the B14:P1.7,16 strain. The Ministry of health decided in 2006 to offer vaccination with this vaccine to people aged 1 to 19 years in Seine- Maritime.

Association of Meningococcal Phenotypes and Genotypes With Clinical Characteristics and Mortality of Meningitis in Children

“…Other factors such as ethnicity, health care practices, population density, and economic factors may contribute to the higher case fatality ratio with the isolates B:14:P1.7,16/ST-32. 29 ST-11 isolates tended to belong to serogroups C (75%), W135 (17.5%) and B (7.5%), while ST-32 isolates belonged to serogroup B in 97.4% of cases and serogroup C in 2.6% of cases. This relatively high proportion of non C serogroups among isolates belonging to CC ST-11 points to possible capsule switching resulting from selective pressure of the immune response to the Men CC vaccine.…”

“…As in most other European countries, serogroup B accounted for most invasive meningococcal infections in our study (62.3% overall). 29 Capsule-based vaccines against serogroup B are not feasible. Vaccines based on outer membrane vesicles can possibly be used to control outbreaks due to these strains.…”

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013

“…While outbreaks of IMD are more commonly associated with serogroup C disease [5,21], prolonged community based and institutional outbreaks of serogroup B disease have been described [22,23]. Control measures in these outbreaks differed.…”

“…Control measures in these outbreaks differed. In a prolonged serogroup B outbreak in northern France (2003France ( -2005, an unlicensed monovalent outer membrane vesicle vaccine from Norway was thought to be affective and was administered initially to high risk groups and subsequently to all the population [22]. In contrast, in a prolonged university outbreak in the United States (2008-2010), health promotion and ciprofloxacin chemoprophylaxis were the control measures used.…”

Does Binding of Complement Factor H to the Meningococcal Vaccine Antigen, Factor H Binding Protein, Decrease Protective Serum Antibody Responses?

“…These strains are also responsible for a disproportionate number of cases in infants Ͻ1 year old (4) and can cause epidemics, such as the ones that occurred in New Zealand in the 1990s (5) and, more recently, in France (6). The serogroup B polysaccharide consists of ␣(2¡8) N-acetylneuraminic acid, which is an auto-antigen (7).…”