Declining Incidence of Invasive Meningococcal Disease in South Africa: 2003-2016.

Adolescent Adult Aged Anti-Bacterial Agents / therapeutic use Child Child, Preschool Coinfection / epidemiology Female HIV Infections / complications Hospital Mortality Humans Incidence Male Meningococcal Infections / drug therapy Microbial Sensitivity Tests Middle Aged Neisseria meningitidis / immunology Risk Factors Serogroup South Africa / epidemiology Young Adult

Neisseria South Africa epidemiology invasive meningococcal disease meningococcus

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

ISSN: 1537-6591

Titre abrégé: Clin Infect Dis

Pays: United States

ID NLM: 9203213

Informations de publication

Date de publication:
18 07 2019

Historique:

received: 18 07 2018

accepted: 19 10 2018

pubmed: 24 10 2018

medline: 14 8 2020

entrez: 24 10 2018

Statut: ppublish

Résumé

Invasive meningococcal disease (IMD) is endemic to South Africa, where vaccine use is negligible. We describe the epidemiology of IMD in South Africa. IMD cases were identified through a national, laboratory-based surveillance program, GERMS-SA, from 2003-2016. Clinical data on outcomes and human immunodeficiency virus (HIV) statuses were available from 26 sentinel hospital sites. We conducted space-time analyses to detect clusters of serogroup-specific IMD cases. Over 14 years, 5249 IMD cases were identified. The incidence was 0.97 cases per 100 000 persons in 2003, peaked at 1.4 cases per 100 000 persons in 2006, and declined to 0.23 cases per 100 000 persons in 2016. Serogroups were confirmed in 3917 (75%) cases: serogroup A was present in 4.7% of cases, B in 23.3%, C in 9.4%; W in 49.5%; Y in 12.3%, X in 0.3%; Z in 0.1% and 0.4% of cases were non-groupable. We identified 8 serogroup-specific, geo-temporal clusters of disease. Isolate susceptibility was 100% to ceftriaxone, 95% to penicillin, and 99.9% to ciprofloxacin. The in-hospital case-fatality rate was 17% (247/1479). Of those tested, 36% (337/947) of IMD cases were HIV-coinfected. The IMD incidence in HIV-infected persons was higher for all age categories, with an age-adjusted relative risk ratio (aRRR) of 2.5 (95% confidence interval [CI] 2.2-2.8; P < .001) from 2012-2016. No patients reported previous meningococcal vaccine exposure. Patients with serogroup W were 3 times more likely to present with severe disease than those with serogroup B (aRRR 2.7, 95% CI 1.1-6.3); HIV coinfection was twice as common with W and Y diseases (aRRR W = 1.8, 95% CI 1.1-2.9; aRRR Y = 1.9, 95% CI 1.0-3.4). In the absence of significant vaccine use, IMD in South Africa decreased by 76% from 2003-2016. HIV was associated with an increased risk of IMD, especially for serogroup W and Y diseases.

Sections du résumé

BACKGROUND

Invasive meningococcal disease (IMD) is endemic to South Africa, where vaccine use is negligible. We describe the epidemiology of IMD in South Africa.

METHODS

IMD cases were identified through a national, laboratory-based surveillance program, GERMS-SA, from 2003-2016. Clinical data on outcomes and human immunodeficiency virus (HIV) statuses were available from 26 sentinel hospital sites. We conducted space-time analyses to detect clusters of serogroup-specific IMD cases.

RESULTS

Over 14 years, 5249 IMD cases were identified. The incidence was 0.97 cases per 100 000 persons in 2003, peaked at 1.4 cases per 100 000 persons in 2006, and declined to 0.23 cases per 100 000 persons in 2016. Serogroups were confirmed in 3917 (75%) cases: serogroup A was present in 4.7% of cases, B in 23.3%, C in 9.4%; W in 49.5%; Y in 12.3%, X in 0.3%; Z in 0.1% and 0.4% of cases were non-groupable. We identified 8 serogroup-specific, geo-temporal clusters of disease. Isolate susceptibility was 100% to ceftriaxone, 95% to penicillin, and 99.9% to ciprofloxacin. The in-hospital case-fatality rate was 17% (247/1479). Of those tested, 36% (337/947) of IMD cases were HIV-coinfected. The IMD incidence in HIV-infected persons was higher for all age categories, with an age-adjusted relative risk ratio (aRRR) of 2.5 (95% confidence interval [CI] 2.2-2.8; P < .001) from 2012-2016. No patients reported previous meningococcal vaccine exposure. Patients with serogroup W were 3 times more likely to present with severe disease than those with serogroup B (aRRR 2.7, 95% CI 1.1-6.3); HIV coinfection was twice as common with W and Y diseases (aRRR W = 1.8, 95% CI 1.1-2.9; aRRR Y = 1.9, 95% CI 1.0-3.4).

CONCLUSIONS

In the absence of significant vaccine use, IMD in South Africa decreased by 76% from 2003-2016. HIV was associated with an increased risk of IMD, especially for serogroup W and Y diseases.

Identifiants

DOI: 10.1093/cid/ciy914 PMID: 30351372 PMC: PMC7848805

pubmed: 30351372

pii: 5142640

doi: 10.1093/cid/ciy914

pmc: PMC7848805

mid: NIHMS1664188

doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

Pagination

495-504

Subventions

Organisme : CGH CDC HHS

ID : U19 GH000571

Pays : United States

Organisme : NCIRD CDC HHS

ID : U51 IP000528

Pays : United States

Investigateurs

John Black (J)

Vanessa Pearce (V)

Anwar Hoosen (A)

Vicky Kleinhans (V)

Alan Karstaedt (A)

Caroline Maluleka (C)

Charl Verwey (C)

Charles Feldman (C)

David Moore (D)

Gary Reubenson (G)

Khine Swe Swe Han (K)

Jeannette Wadula (J)

Jeremy Nel (J)

Kathy Lindeque (K)

Maphoshane Nchabeleng (M)

Nazlee Samodien (N)

Nicolette du Plessis (N)

Norma Bosman (N)

Ranmini Kularatne (R)

Sharona Seetharam (S)

Teena Thomas (T)

Theunis Avenant (T)

Trusha Nana (T)

Vindana Chibabhai (V)

Adhil Maharj (A)

Asmeeta Burra (A)

Fathima Naby (F)

Halima Dawood (H)

Jade Mogamberry (J)

Koleka Mlisana (K)

Lisha Sookan (L)

Praksha Ramjathan (P)

Prasha Mahabeer (P)

Romola Naidoo (R)

Sumayya Haffejee (S)

Yacoob Coovadia (Y)

Ken Hamese (K)

Ngoaka Sibiya (N)

Ruth Lekalakala (R)

Greta Hoyland (G)

Jacob Lebudi (J)

Pieter Jooste (P)

Ebrahim Variava (E)

Erna du Plessis (E)

Andrew Whitelaw (A)

Kessendri Reddy (K)

Mark Nicol (M)

Preneshni Naicker (P)

Adrian Brink (A)

Elizabeth Prentice (E)

Inge Zietsman (I)

Maria Botha (M)

Peter Smith (P)

Xoliswa Poswa (X)

Chetna Govind (C)

Keshree Pillay (K)

Suzy Budavari (S)

Catherine Samuel (C)

Marthinus Senekal (M)

Andries Dreyer (A)

Khatija Ahmed (K)

Louis Marcus (L)

Warren Lowman (W)

Angeliki Messina (A)

Dena van den Bergh (D)

Karin Swart (K)

Cynthia Whitney (C)

Keith Klugman (K)

Ananta Nanoo (A)

Andries Dreyer (A)

Anne von Gottberg (A)

Anthony Smith (A)

Arvinda Sooka (A)

Cecilia Miller (C)

Charlotte Sriruttan (C)

Cheryl Cohen (C)

Chikwe Ihekweazu (C)

Claire von Mollendorf (C)

Desiree du Plessis (D)

Erika Britz (E)

Frans Radebe (F)

Genevie Ntshoe (G)

Gillian Hunt (G)

Hlengain Mathema (H)

Jacqueline Weyer (J)

Jenny Rossouw (J)

John Frean (J)

Karen Keddy (K)

Kerrigan McCarthy (K)

Linda de Gouveia (L)

Linda Erasmus (L)

Lucille Blumberg (L)

Marshagne Smith (M)

Martha Makgoba (M)

Motshabi Modise (M)

Nazir Ismail (N)

Nelesh Govender (N)

Neo Legare (N)

Nicola Page (N)

Ntsieni Ramalwa (N)

Nuraan Paulse (N)

Phumeza Vazi (P)

Olga Perovic (O)

Penny Crowther-Gibson (P)

Portia Mutevedzi (P)

Riyadh Manesen (R)

Ruth Mpembe (R)

Sarona Lengana (S)

Shabir Madhi (S)

Sibongile Walaza (S)

Sonwabo Lindani (S)

Sunnieboy Njikho (S)

Susan Meiring (S)

Thejane Motladiile (T)

Tiisetso Lebaka (T)

Verushka Chetty (V)

Informations de copyright

Références

Clin Infect Dis. 2015 Apr 15;60(8):e27-35

pubmed: 25605282

Expert Rev Vaccines. 2010 Mar;9(3):285-98

pubmed: 20218857

Hum Vaccin Immunother. 2015;11(4):875-83

pubmed: 25714390

MMWR Morb Mortal Wkly Rep. 2011 Jan 28;60(3):72-6

pubmed: 21270745

Expert Rev Vaccines. 2017 Apr;16(4):313-328

pubmed: 27820969

Pathog Glob Health. 2013 Oct;107(7):373-80

pubmed: 24392681

PLoS One. 2017 May 4;12(5):e0175721

pubmed: 28472165

N S W Public Health Bull. 2013 Dec;24(3):119-24

pubmed: 24360208

PLoS One. 2017 Jul 3;12(7):e0179905

pubmed: 28671978

Paediatr Drugs. 2016 Apr;18(2):83-7

pubmed: 26913860

J Infect. 2017 Jul;75(1):1-11

pubmed: 28455205

MMWR Morb Mortal Wkly Rep. 2016 Nov 04;65(43):1189-1194

pubmed: 27811836

Lancet Infect Dis. 2016 Nov;16(11):1288-1294

pubmed: 27567107

AIDS. 2015 Jul 17;29(11):1401-9

pubmed: 26091299

PLoS One. 2011 May 05;6(5):e19361

pubmed: 21573213

JAMA. 1984 Oct 12;252(14):1905-7

pubmed: 6471323

Int Health. 2016 Nov;8(6):369-371

pubmed: 27620924

Clin Infect Dis. 2010 Jan 15;50(2):184-91

pubmed: 20001736

Glob Health Action. 2016 Jun 08;9:30314

pubmed: 27282146

BMJ Open. 2017 Jun 6;7(5):e015080

pubmed: 28592578

Vaccine. 2015 Nov 27;33(48):6529-36

pubmed: 26597036

Commun Dis Intell Q Rep. 2016 Dec 24;40(4):E454-E459

pubmed: 28043219

PLoS One. 2017 Nov 30;12(11):e0188595

pubmed: 29190699

J Clin Microbiol. 2012 Aug;50(8):2577-84

pubmed: 22593593

J Clin Microbiol. 2012 Mar;50(3):702-8

pubmed: 22170919

Pathog Glob Health. 2014 Jan;108(1):11-20

pubmed: 24548156

Antimicrob Agents Chemother. 2003 Nov;47(11):3554-60

pubmed: 14576117

Ann Intern Med. 2014 Jan 7;160(1):30-7

pubmed: 24166695

Popul Health Metr. 2013 Sep 10;11(1):17

pubmed: 24016339

Emerg Infect Dis. 2007 Feb;13(2):273-81

pubmed: 17479891

Ann Trop Paediatr. 1987 Mar;7(1):47-53

pubmed: 2439004

Pediatr Infect Dis J. 2017 Jul;36(7):e203-e207

pubmed: 28027288

Med J Aust. 2017 Nov 6;207(9):382-387

pubmed: 29092704

PLoS One. 2015 Jun 11;10(6):e0128580

pubmed: 26068416

AIDS. 2010 Jun 1;24(9):1351-60

pubmed: 20559040

Clin Infect Dis. 2018 Apr 3;66(8):1276-1281

pubmed: 29126310

Vaccine. 2017 Jan 5;35(2):208-211

pubmed: 27923519

BMC Med. 2015 Dec 09;13:297

pubmed: 26654248

Vaccine. 2013 Aug 28;31(38):4200-8

pubmed: 23684826

Clin Infect Dis. 2008 Feb 1;46(3):377-86

pubmed: 18181736

N Engl J Med. 2014 Nov 13;371(20):1889-99

pubmed: 25386897