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.
Journal Information
Vol. 14. Issue 3.
Pages 242-251 (May - June 2010)
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
Visits
2832
David Eduardo Barroso1,2,3,
, D.M. Carvalho2, S.T. Casagrande4, M.C. Rebelo1, V. Soares1, V. Zahner3, C.A. Solari5, S.A. Nogueira1,2
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.
Correspondence to: Laboratório de Sistemática Bioquímica, Instituto Oswaldo Cruz Av. Brasil, 4365 Rio de Janeiro – RJ – Brazil CEP: 21040-900.
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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Article information
Abstract
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?.
Lancet, 2 (1982), pp. 595-597
[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.
Bmj, 333 (2006), pp. 685-690
[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.
Lancet, 367 (2006), pp. 397-403
[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.
[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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