The epidemiology and management of clusters of invasive meningococcal disease in England, 2010–15

Gobin, Maya; Hughes, G.; Foulkes, Sarah; Bagnall, Helen; Trindall, Amy; Decraene, Valérie; Edeghere, Obaghe; Balasegaram, Sooria; Cummins, Amelia; Coole, Louise

doi:10.1093/pubmed/fdz028

Cited by 3 publications

(9 citation statements)

References 11 publications

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“…Meningococcal serogroup C (Men-C) conjugated vaccine was introduced in the UK in 1999, and the cases of IMD fell dramatically by over 90% in immunized age groups and indirectly, by two-thirds in other age groups due to reduced carriage and exposure. The emergence of serogroup B and serogroup W led to the introduction of meningococcal serogroup B (MenB) vaccine in infant immunization schedule in 2015 and the replacement of MenC with meningococcal (Men) ACWY vaccine in adolescents, respectively [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

et al. 2022

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Background Invasive meningococcal disease (IMD) causes high fatality in untreated patients alongside long-term sequelae in 20% survivors. For a comprehensive assessment of epidemiology, an analysis of these sequelae is required. This study aims to investigate the epidemiology of disease between 2008 and 2017 including a description of the sequelae, through the analysis of data collected from the UK Clinical Practice Research Datalink (CPRD) linked with data from the Hospital Episode Statistics (HES), and Office for National Statistics (ONS) mortality registry data. Methods This was a 10-year retrospective observational cohort study designed to describe the incidence, case-fatality rate (CFR) and occurrence of sequelae due to meningococcal disease, in the UK between 2007 and 2017 using data from the UK CPRD-HES-ONS. Cases were identified and matched on age, gender, date of diagnosis of IMD and followed-up-time with a control group without IMD. Demographics, clinical characteristics, mortality, and IMD-related sequelae were examined for IMD cases and compared with matched controls for a more comprehensive assessment. Results The study analysed 640 IMD patients with majority of the cases diagnosed (76.9%) in a hospital setting. Age-group analysis showed a decrease in the incidence rate of IMD in patients aged <1 year (30.4 – 7.5%) and an increase in those >50 years (10.4 – 27.8%). CFR was slightly higher among females, toddlers, and adults >50 years. No significant change in CFR was observed over study period. Case-control study showed a higher number of IMD sequelae among cases compared to age- and gender-matched controls, especially in those ≥ 50 years. Conclusion The study showed that, despite a relatively low incidence rate, IMD is responsible for a high CFR, namely in older age groups and by a high number of IMD sequelae. The study showed that leveraging data from existing databases can be used to complement surveillance data in truly assessing the epidemiology of IMD. Despite the availability of routine vaccination programs, IMD still poses a significant burden in the healthcare system of the UK. Optimization of vaccination programs may be required to reduce the disease burden.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

et al. 2022

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“…Most of the IMD outbreaks described in the literature concern two or three cases and occur within 21 days -often during the first week -following the first case [7][8][9]. The 9-month duration of this outbreak in a nursery school, with intervals of 2 and 7 months between cases, is quite uncommon.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of invasive meningococcal disease caused by a meningococcus serogroup B in a nursery school, Wallonia, Belgium, 2018

et al. 2022

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Although most invasive meningococcal disease (IMD) cases are sporadic without identified transmission links, outbreaks can occur. We report three cases caused by meningococcus B (MenB) at a Belgian nursery school over 9 months. The first two cases of IMD occurred in spring and summer 2018 in healthy children (aged 3–5 years) attending the same classroom. Chemoprophylaxis was given to close contacts of both cases following regional guidelines. The third case, a healthy child of similar age in the same class as a sibling of one case, developed disease in late 2018. Microbiological analyses revealed MenB with identical finetype clonal complex 269 for Case 1 and 3 (unavailable for Case 2). Antimicrobial susceptibility testing revealed no antibiotic resistance. Following Case 3, after multidisciplinary discussion, chemoprophylaxis and 4CMenB (Bexsero) vaccination were offered to close contacts. In the 12-month follow-up of Case 3, no additional cases were reported by the school. IMD outbreaks are difficult to manage and generate public anxiety, particularly in the case of an ongoing cluster, despite contact tracing and management. This outbreak resulted in the addition of MenB vaccination to close contacts in Wallonian regional guidelines, highlighting the potential need and added value of vaccination in outbreak management.

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“…Public health staff require clear and accurate guidance in order to effectively identify and reduce the risk of further IMD cases arising from contacts of those cases [ 28 ]. Domains within those guidelines with lower scores in the AGREE II Instrument indicate areas where public health staff lack consistent and explicit guidance on how to carry out their role concerning management of close contacts.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on the prevalence of asymptomatic carriage have largely focussed on sub-populations already known to have higher rates of carriage, and often utilize surveys and questionnaires to identify factors that may affect an individual’s risk of carriage [ [30] , [31] , [32] ]. Guideline recommendations are then based on the generalised results of these population studies, in addition to public health records of previous IMD clusters [ 28 ] and published evidence on the transmission risk of similar bacterial pathogens (e.g. tuberculosis) [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study is a repeat of a 2007 survey [ 35 ], and indicated that following the publication of the ECDC guidance in 2010, EU countries had adopted more evidence-based public health guidance, that were better aligned with ECDC recommendations. This indicates that while there is a somewhat limited understanding of the risks affecting transmission of N. meningitidis , it has become more widely accepted that to be at a higher risk of transmission, a certain degree of close, sustained contact is required [ 16 , 28 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Lessons for and from the COVID-19 pandemic response — An appraisal of guidance for the public health management of Invasive Meningococcal Disease

Morello¹,

Milazzo²,

Marshall³

et al. 2021

Journal of Infection and Public Health

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Background COVID-19 has focussed public attention on the management of communicable disease like never before. Surveillance, contact tracing, and case management are recognized as key components of outbreak prevention. Development of guidance for COVID-19 has drawn from existing management of other communicable diseases, including Invasive Meningococcal Disease (IMD). IMD is a rare but severe outcome of Neisseria meningitidis infection that can be prevented through vaccination. Cases still occur sporadically, requiring ongoing surveillance and consistent management. To this end, national and international public health agencies have developed and published guidance for identification and management of IMD cases. Aim To assess national and international guidelines for the public health management of IMD, with a focus on the recommendations for identification and management of “close contacts” to IMD cases. Methods Guidelines from six national and international public health agencies were assessed using a modified version of the Appraisal of Guidelines, Research and Evaluation (AGREE II) Instrument in four key domains: stakeholder involvement, developmental rigour, clarity, and applicability. A direct comparison of terminology and recommendations for identification and management of close contacts to IMD cases was also conducted. Results Guidelines from Europe and the United Kingdom rated most highly using the AGREE II Instrument, both presenting a clear, critical assessment of the strength of the available evidence, and the risks, costs, and benefits behind recommendations for management of close contacts. Direct comparison of guidelines identified inconsistencies in the language defining close contacts to IMD cases. Conclusion Discrepancies between guidelines could be due to limited evidence concerning mechanisms behind disease transmission, along with the lack of a consistent process for development and review of guideline recommendations. COVID-19 management has demonstrated that international collaboration for development of public health guidance is possible, a practice that should be extended to management of other communicable diseases.

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The epidemiology and management of clusters of invasive meningococcal disease in England, 2010–15

Cited by 3 publications

References 11 publications

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

Outbreak of invasive meningococcal disease caused by a meningococcus serogroup B in a nursery school, Wallonia, Belgium, 2018

Lessons for and from the COVID-19 pandemic response — An appraisal of guidance for the public health management of Invasive Meningococcal Disease

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