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Vol. 14. Issue 3.
Pages 242-251 (May - June 2010)
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Vol. 14. Issue 3.
Pages 242-251 (May - June 2010)
Original article
Open Access
Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil
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2832
David Eduardo Barroso1,2,3,
Corresponding author
barroso@ioc.fiocruz.br

Correspondence to: Laboratório de Sistemática Bioquímica, Instituto Oswaldo Cruz Av. Brasil, 4365 Rio de Janeiro – RJ – Brazil CEP: 21040-900.
, D.M. Carvalho2, S.T. Casagrande4, M.C. Rebelo1, V. Soares1, V. Zahner3, C.A. Solari5, S.A. Nogueira1,2
1 Instituto Estadual de Infectologia São Sebastião, Rio de Janeiro, RJ, Brazil
2 Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
3 Department of Biochemistry and Molecular Biology, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
4 Bacteriology Section, Instituto Adolfo Lutz, São Paulo, SP, Brazil
5 Department of Bacteriology, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Abstract

The main objectives of the present study were to investigate the clinical and laboratory features of meningococcal disease in the city of Rio de Janeiro, Brazil, during the overlap of 2 epidemics in the 1990s. We conducted a study of a series of cases of meningococcal disease admitted in a Meningitis Reference Hospital. All clinical isolates available were analyzed by means of microbiological epidemiological markers. In 1990, Neisseria meningitidis serogroup B:4,7:P1.19,15, 1.7,1 sulfadiazine-resistant of the ET-5 complex emerged causing epidemic disease. Despite mass vaccination campaign (VaMengoc B+C®), the ET-5 clone remained hyperendemic after the epidemic peaked. In 1993 to 1995, an epidemic of serogroup C belonged to the cluster A4 overlapped, with a significant shift in the age distribution toward older age groups and an increase of sepsis. Serogroup C epidemics are a recurrent problem in Rio de Janeiro, which can be hindered with the introduction of a conjugate vaccine. We hope the data presented here brings useful information to discuss vaccines strategies and early management of suspected cases.

Keywords:
Neisseria meningitidis
meningococcal disease
epidemic
meningitis
sepsis
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References
[1.]
DMEG - Doença Meningocócica no Estado da Guanabara.
Bol Epidemiol, 6 (1974), pp. 171-176
[2.]
A.P.S. Lemos, T.Y. Yara, M.C.O. Gorla, et al.
Clonal distribution of invasive Neisseria meningitidis serogroup C strains circulating from 1976 to 2005 in greater São Paulo, Brazil.
J Clin Microbiol, 45 (2007), pp. 1266-1273
[3.]
C.P. Noronha, C.J. Struchiner, M.E. Halloran.
Assessment of the direct effectiveness of BC meningococcal vaccine in Rio de Janeiro. Brazil: a case-control study.
Int J Epidemiol, 24 (1995), pp. 1050-1057
[4.]
L.G.F. Pedro, R.F. Boente, D.J. Madureira, et al.
Diagnosis of meningococcal meningitis in Brazil by use of PCR.
Scand J Infect Dis, 39 (2007), pp. 28-32
[5.]
R.K. Selander, D.A. Caugant, H. Ochman, J.M. Musser, M.N. Gilmour, T.S. Whittam.
Methods of multilocus enzyme electrophoresis for bacterial population genetics and systematics.
Appl Environ Microbiol, 51 (1986), pp. 873-884
[6.]
Meningococcal Disease Surveillance Group.
Meningococcal disease: secondary attack rate and chemoprophylaxis in the United States, 1974.
JAMA, 235 (1976), pp. 261-265
[7.]
P.H.A. Sneath, R.R. Sokal.
Numerical Taxomomy.
The Principle and Practice of Numerical Classification, pp. 131-133
[8.]
D.S. Stephens, B. Greenwood, P. Brandtzaeg.
Epidemic meningitis, meningococcaemia, and Neisseria meningitidis.
Lancet, 369 (2007), pp. 2196-2210
[9.]
K.A. Cartwright, J.M. Stuart, N.D. Noah.
An outbreak of meningococcal disease in Gloucestershire.
Lancet, 2 (1986), pp. 558-561
[10.]
B.T. McGuinness, I.N. Clarke, P.R. Lambden, et al.
Point mutation in meningococcal por A gene associated with increased endemic disease.
Lancet, 337 (1991), pp. 514-517
[11.]
C.T. Sacchi, R.C. Zanella, D.A. Caugant, et al.
Emergence of a new clone of serogroup C Neisseria meningitidis in São Paulo. Brazil.
J Clin Microbiol, 30 (1992), pp. 1282-1286
[12.]
R.C.C. Bertoncini, R.A. Herberts, M.G. Dário, R.C. Merlin, L.C. Miletti.
Epidemiological study of Neisseria meningitidis strains isolated from cases of meningococcal disease in Santa Catarina State, Brazil.
Public Health, 121 (2007), pp. 880-883
[13.]
D.M. Jones, R.H. Mallard.
Age incidence of meningococcal infection England and Wales, 1984-1991.
J Infect, 27 (1993), pp. 83-88
[14.]
W.E. Bell, W.F. McCormick.
Meningococcal meningitis.
Neurological Infectious in Children, pp. 155-175
[15.]
H. Peltola, J.M. Kataja, P.H. Makela.
Shift in the age-distribution of meningococcal disease as predictor of an epidemic?.
[16.]
B.M. Greenwood.
Meningococcal disease.
Hunter's Tropical Medicine, pp. 385-399
[17.]
P.S. Moore, C.V. Broome.
Cerebrospinal meningitis epidemics.
Sci Am, 271 (1994), pp. 38-45
[18.]
F.A. Riordan, O. Marzouk, A.P. Thomson, J.A. Sills, C.A. Hart.
The changing presentations of meningococcal disease.
Eur J Pediatr, 154 (1995), pp. 472-474
[19.]
F.E. Ashton, J.A. Ryan, A. Borczyk, D.A. Caugant, L. Mancino, D. Huang.
Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada.
J Clin Microbiol, 29 (1991), pp. 2489-2493
[20.]
M. Ramsay, E. Kaczmarski, M. Rush, R. Mallard, P. Farrington, J. White.
Changing patterns of case ascertainment and trends in meningococcal disease in England and Wales.
Commun Dis Rep CDR Rev, 7 (1997), pp. R49-54
[21.]
N. Barquet, P. Domingo, J.A. Caylà, et al.
Meningococcal disease in a large urban population (Barcelona, 1987-1992): predictors of dismal prognosis. Barcelona Meningococcal Disease Surveillance Group.
Arch Intern Med, 159 (1999), pp. 2329-2340
[22.]
E.D. Carrol, A.P. Thomson, P. Shears, S.J. Gray, E.B. Kaczmarski, C.A. Hart.
Performance characteristics of the polymerase chain reaction assay to confirm clinical meningococcal disease.
Arch Dis Child, 83 (2000), pp. 271-273
[23.]
R. Finn, C. Groves, M. Coe, M. Pass, L.H. Harrison.
Cluster of serogroup C meningococcal disease associated with attendance at a party.
South Med J, 94 (2001), pp. 1192-1194
[24.]
E. Ferreira, R. Dias, M. Caniça.
Antimicrobial susceptibility, serotype and genotype distribution of meningococci in Portugal, 2001-2002.
Epidemiol Infect, 134 (2006), pp. 1203-1207
[25.]
I. Smith, D.A. Caugant, E.A. Hoiby, T. Wentzel-Larsen, A. Halstensen.
High case-fatality rates of meningococcal disease in Western Norway caused by serogroup C strains belonging to both sequence type (ST)-32 and ST-11 complexes, 1985-2002.
Epidemiol Infect, 134 (2006), pp. 1195-1202
[26.]
R.J. Scholten, H.A. Bijlmer, H.A. Valkenburg, J. Dankert.
Patient and strain characteristics in relation to the outcome of meningococcal disease: a multivariate analysis.
Epidemiol Infect, 112 (1994), pp. 115-124
[27.]
R.J. Scholten, H.A. Bijlmer.
Excess female fatalities among patients with meningococcal disease.
Int J Epidemiol, 24 (1995), pp. 244-245
[28.]
D.S. Stephens, R.A. Hajjeh, W.S. Baughman, R.C. Harvey, J.D. Wenger, M.M. Farley.
Sporadic meningococcal disease in adults: results of a 5-year population-based study.
Ann Intern Med, 123 (1995), pp. 937-940
[29.]
J. Andersen, V. Backer, P. Voldsgaard, P. Skinhoj, J.H. Wandall.
Acute meningococcal meningitis: analysis of features of the disease according to the age of 255 patients. Copenhagen Meningitis Study Group.
J Infect, 34 (1997), pp. 227-235
[30.]
L.H. Harrison, M.A. Pass, A.B. Mendelsohn, et al.
Invasive meningococcal disease in adolescents and young adults.
JAMA, 286 (2001), pp. 694-699
[31.]
A. Skoczynska, M. Kadlubowski, J. Knap, M. Szulc, M. Janusz-Jurczyk, W. Hryniewicz.
Invasive meningococcal disease associated with a very high case fatality rate in the North-West of Poland.
FEMS Immunol Med Microbiol, 46 (2006), pp. 230-235
[32.]
A.J. Pollard, J. Britto, S. Nadel, C. DeMunter, P. Habibi, M. Levin.
Emergency management of meningococcal disease.
Arch Dis Child, 80 (1999), pp. 290-296
[33.]
C.A. Hart, A.P. Thomson.
Meningococcal disease and its management in children.
[34.]
F.A. Riordan, A.P. Thomson.
Recognition, treatment and complications of meningococcal disease.
Paediatr Drugs, 1 (1999), pp. 263-282
[35.]
J. Britto, S. Nadel, I. Maconochie, M. Levin, P. Habibi.
Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team.
Bmj, 311 (1995), pp. 836-839
[36.]
F.A. Riordan, A.P. Thomson, J.A. Sills, C.A. Hart.
Who spots the spots? Diagnosis and treatment of early meningococcal disease in children.
Bmj, 313 (1996), pp. 1255-1256
[37.]
S. Nadel, J.S. Kroll.
Diagnosis and management of meningococcal disease: the need for centralized care.
FEMS Microbiol Rev, 31 (2007), pp. 71-83
[38.]
G.L. Werneck, D.M. de Carvalho, D.E. Barroso, E.F. Cook, A.M. Walker.
Classification trees and logistic regression applied to prognostic studies: a comparison using meningococcal disease as an example.
J Trop Pediatr, 45 (1999), pp. 248-251
[39.]
M.J. Thompson, N. Ninis, R. Perera, et al.
Clinical recognition of meningococcal disease in children and adolescents.
[40.]
M. Achtman.
Molecular epidemiology of epidemic bacterial meningitis.
Rev Med Microbiol, 1 (1990), pp. 29-38
[41.]
J.A. Bygraves, R. Urwin, A.J. Fox, S.J. Gray, J.E. Russell, I.M. Feavers, M.C.J. Maiden.
Population genetic and evolutionary approaches to analysis of Neisseria meningitidis isolates belonging to the ET-5 complex.
J Bacteriol, 181 (1999), pp. 5551-5556
[42.]
M. Guibourdenche, E.A. Hoiby, J.Y. Riou, F. Varaine, C. Joguet, D.A. Caugant.
Epidemics of serogroup A Neisseria meningitidis of subgroup III in Africa, 1989-94.
Epidemiol Infect, 116 (1996), pp. 115-120
[43.]
C.T. Sacchi, L.L. Pessoa, S.R. Ramos, et al.
Ongoing group B Neisseria meningitidis epidemic in São Paulo. Brazil, due to increased prevalence of a single clone of the ET-5 complex.
J Clin Microbiol, 30 (1992), pp. 1734-1738
[44.]
D.A. Caugant, L.O. Froholm, R.K. Selander, K. Bovre.
Sulfonamide resistance in Neisseria meningitidis isolates of clones of the ET-5 complex.
Apmis, 97 (1989), pp. 425-428
[45.]
J.S. Swartley, A.A. Marfin, S. Edupuganti, et al.
Capsule switching of Neisseria meningitidis.
Proc Natl Acad Sci U S A, 94 (1997), pp. 271-276
[46.]
R.C. Puricelli, E. Kupek, R.C. Bertoncini.
Control of a community outbreak of group C meningococcal meningitis in Corupa, Santa Catarina State. Brazil, based on rapid and effective epidemiological surveillance and immunization.
Cad Saúde Pública, 20 (2004), pp. 959-967
[47.]
N. Begg.
Outbreak management.
Meningococcal Disease, pp. 285-305
[48.]
A.C.I.P.
Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendations of the Advisory Committee on Immunization Practices (ACIP), 46 (1997), pp. 13-21
[49.]
D.A. Caugant.
Population genetics and molecular epidemiology of Neisseria meningitidis.
Apmis, 106 (1998), pp. 505-525
[50.]
W.H.O. Control of edipemic meningococcal disease. World Health Organization, 1998.
[51.]
D. Brahams.
Meningitis, schools, and public alarm.
Lancet, 339 (1992), pp. 1532
[52.]
B. Alcalá, L. Arreaza, C. Salcedo, M.J. Uría, L. De La Fuente, J.A. Vázquez.
Capsule switching among C:2b:P1.2. 5 meningococcal epidemic strains after mass immunization campaign, Spain.
Emerg Infect Dis, 8 (2002), pp. 1512-1514
[53.]
P. Stefanelli, C. Fazio, A. Neri, T. Sofia, P. Mastrantonio.
Emergence in Italy of a Neisseria meningitidis clone with decreased susceptibility to penicillin.
Antimicrob Agents Chemother, 48 (2004), pp. 3103-3106
[54.]
L. Arreaza, C. Salcedo, B. Alcalá, et al.
Sequencing of Neisseria meningitidis penA gene: the key to success in defining penicillin G breakpoints.
Antimicrob Agents Chemother, 48 (2004), pp. 358-359
[55.]
S. Uriz, V. Pineda, M. Grau, et al.
Neisseria meningitidis with reduced sensitivity to penicillin: observations in 10 children.
Scand J Infect Dis, 23 (1991), pp. 171-174
[56.]
C.R. Woods, A.L. Smith, B.L. Wasilauskas, J. Campos, L.B. Givner.
Invasive disease caused by Neisseria meningitidis relatively resistant to penicillin in North Carolina.
J Infect Dis, 170 (1994), pp. 453-456
[57.]
S. Brown, G. Riley, F. Jamieson.
Neisseria meningitidis with decreased susceptibility to penicillin in Ontario. Canada 1997-2000.
Can Commun Dis Rep, 27 (2001), pp. 73-75
[58.]
J.A. Vazquez, R. Enriquez, R. Abad, B. Alcala, C. Salcedo, L. Arreaza.
Antibiotic resistant meningococci in Europe: any need to act?.
FEMS Microbiol Rev, 31 (2007), pp. 64-70
[59.]
W.E. Bell.
Bacterial meningitis in children. Selected aspects.
Pediatr Clin North Am, 39 (1992), pp. 651-668
[60.]
J. Decosas, J.B. Koama.
Chronicle of an outbreak foretold: meningococcal meningitis W135 in Burkina Faso.
Lancet Infect Dis, 2 (2002), pp. 763-765
[61.]
H. Peltola.
Early meningococcal disease: advising the public and the profession.
Lancet, 342 (1993), pp. 509-510
[62.]
A.P.J. Thomson, F.A.I. Riordan.
The management of meningococcal disease.
Curr Paediatr, 10 (2000), pp. 104-109
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