Serogroup Y Meningococcal Disease in Chicago, 1991-1997

Abstract

Context.-In 1994, surveillance by the Chicago Department of Public Health detected a growing trend in the proportion of invasive meningococcal infections caused by serogroup Y. Objective.-To examine the emergence of serogroup Y meningococcal disease and compare its clinical characteristics with those of other meningococcal serogroups. Design.-Population-based retrospective review of surveillance records; medical record review and cohort analysis of serogroup Y vs non-serogroup Y case patients. Setting.-Chicago, Ill. Participants.-City residents with Neisseria meningitidis isolated from a normally sterile site from January 1, 1991, through December 31, 1997; cohort analysis included those identified through March 31, 1996. Main Outcome Measures.-Serogroup-specific incidence, demographics, and clinical outcomes. Results.-We identified 214 case patients; 53 (25%) had serogroup Y. The attack rate of serogroup Y meningococcal disease increased from 0.04 cases per 100 000 in 1991 to a peak of 0.82 cases per 100 000 in 1995 and subsequently decreased to 0.26 cases per 100 000 and 0.34 cases per 100 000 in 1996 and 1997, respectively. Compared with patients infected by other serogroups, patients with serogroup Y were older (median age, 16 years vs 1 year; P = .001) and more likely to have a chronic underlying illness (prevalence ratio, 2.3; 95% confidence interval, 1.2-4.4). Outcome did not differ significantly between the 2 groups. Multilocus enzyme electrophoresis typing of isolates from 19 case patients identified 5 different types. We found no clustering among the enzyme types by age, race/ethnicity, community area, or time. Conclusions.-Serogroup Y emerged as the most frequent cause of meningococcal disease in Chicago in 1995 and accounted for a substantial proportion of cases in 1996 and 1997. Current data suggest that the magnitude of serogroup Y meningococcal disease is sufficient for vaccine developers to incorporate serogroup Y into new vaccines.

En ung mann med luftveisinfeksjon og ansiktsutslett

“…Several studies have found this serogroup to be most frequently associated with pneumonia (12,13). Patients infected with serogroup Y are often older and have comorbid conditions (11,12), in contrast to our patient, who was a young and previously healthy man.…”

“…According to population-based retrospective studies of data from monitoring meningococcal disease, where N. meningitidis has been isolated from blood and/or cerebrospinal fluid (CSF), 6-15 % of patients with invasive meningococcal disease develop pneumonia (11,12).…”

Vaccines based on the cell surface carbohydrates of pathogenic bacteria

“…Whilst Haemophilus influenzae disease is caused overwhelmingly by a single serotype, the type b, pneumococcal disease is caused by a very large number of the ninety known serotypes. Meningococcal disease in developed countries is principally Groups B and C, although Groups W135 and Y are becoming increasingly important, and Group A disease is virtually unknown (Racoosin et al 1998, Mayer et al 2002. Meningococcal Group A strains are, however, responsible for the regular meningitis epidemics which plague subSaharan Africa.…”

Genetic and Antigenic Analysis of Invasive Serogroup Y Neisseria meningitidis Isolates Collected from 1999 to 2003 in Canada

“…Furthermore, there are geographical differences in the serogroup distribution of N. meningitidis strains causing IMD. For instance, in Canada (32) and the United States (22,25) serogroup Y meningococci have been responsible for a noticeable proportion of all IMD cases. This is in contrast to most European countries (8), where serogroup Y N. meningitidis causes only a small percentage of all IMD and is often found in healthy carriers (7,40).…”