Trends and variations in the epidemiology of meningococcal disease in Kuwait 1987–2013

Abstract

The introduction of Haemophilus influenzae type b (Hib) conjugate vaccine and conjugate pneumococcal vaccine into routine childhood vaccination in Kuwait has resulted in the emergence of Neisseria meningitidis as the leading cause of invasive bacterial infection in children. Currently, a quadrivalent ACYW-135 meningococcal polysaccharide vaccine is administered as part of routine childhood vaccination in Kuwait at the age of 2 years. Conjugate meningococcal vaccines have been shown to be more effective in preventing meningococcal infection in young children. The objective of this study was to describe the epidemiology of meningococcal disease (MD) in Kuwait and evaluate the need for conjugate vaccine in routine childhood immunization. We have reviewed the MD surveillance data from the communicable disease unit, Ministry of Health, Kuwait during the period from 1987 to 2013. The analysis included microbiologically confirmed cases of N. meningitidis in the blood and cerebrospinal fluid. There were 293 cases of confirmed MD during the study period. Two hundred and four cases (70%) were in children ≤ 14 years of age. The mean incidence rate was 0.5/100,000 persons. The dominant serogroups were W-135 and B, accounting for 80 cases (32%) each. Serogroup B accounted for 69/204 (34%) of all cases in children ≤ 14 years and serogroup A accounted for 36/89 40% of all adult cases. There were three outbreaks: 1987 (caused by serogroup A), 1989 (caused by serogroup W-135) and 2002 (caused by serogroup B). The mean case fatality rate was 13.5%. In conclusion, despite childhood routine vaccination with ACYW-135 polysaccharide vaccine, infants and young children remain at high risk for MD, which supports the introduction of conjugate meningococcal vaccine to the routine childhood vaccination schedule.

A Review of Meningococcal Disease and Vaccination Recommendations for Travelers

“…Serogroup B accounted for 34% of all cases in children ≤ 14 years, and serogroup A accounted for 40% of all adult cases. Three outbreaks in Kuwait in 1987, 1989, and 2002 were caused by serogroups A, W, and B, respectively [ 30 ].…”

The Burden of Invasive Vaccine-Preventable Diseases in Adults in the Middle East and North Africa (MENA) Region

“…Of the 30 articles retrieved in the NM literature search, 8 were included in the analysis (2 publications each from Iran [33,34] and Turkey [35,36] and single publications from Egypt [37], Kuwait [38], Saudi Arabia [39], and Yemen [40]) (Fig. 1; Table 2).…”

“…1; Table 2). Of the identified publications, two were based on national surveillance [38,39], with the remaining being smaller studies (e.g., hospital/school based) [33][34][35][36][37]. Five studies reported on disease epidemiology [33,[37][38][39][40] and three on carriage epidemiology [34][35][36] for NM among adults in MENA.…”

“…The two national studies identified in the literature search from Kuwait and Saudi Arabia are most informative regarding the epidemiology of meningococcal disease within the MENA region [38,39]. In the first study, whereas infants and children represented the largest percentages of meningococcal disease cases occurring from 1987 to 2003 in Kuwait, those aged C 14 years were also at considerable risk, with nearly onethird of cases occurring in this age group [38]. This study found an 82% decreased incidence in meningococcal disease across the entire population over the prior 27 years, corresponding to implementation of national surveillance activities.…”

Kuwait Recommendations on Vaccine Use in People with Inflammatory Rheumatic Diseases

“…Kuwait occupies an area of just under 18,000 square kilometres at the tip of the Arabian Gulf and has a population of 4 million. The Kuwaiti Ministry of Health (MOH) is the major provider of healthcare, although in recent years there has been an emerging contribution from private healthcare clinics [ 17 ].…”