ReviewGlobal epidemiology of meningococcal disease
Introduction
Neisseria meningitidis is a major cause of invasive bacterial infections globally [1], [2], [3]. A notable feature of the meningococcus is its fluid epidemiology. There are substantial cyclical fluctuations in meningococcal disease incidence and the occurrence of outbreaks and epidemics. Furthermore, meningococcal incidence and serogroup distribution are highly regional. The purpose of this review is to discuss the current global epidemiology of meningococcal disease in major areas of the world, including recent changes. As most information derives from disease surveillance, apparent differences in epidemiology can only be understood in the context of the underlying surveillance systems. A major focus of this review is information on regional meningococcal disease incidence and the serogroup distribution of meningococcal strains causing invasive disease, key issues for vaccine formulation and immunization policy.
Section snippets
Types of surveillance for meningococcal infection
Meningococcal disease surveillance is required for the assessment of local epidemiology and assessments of disease burden. There are a variety of methods for conducting meningococcal surveillance, which vary in their ability to accurately portray the epidemiology [4]. The gold standard is laboratory-based surveillance, which specifically identifies N. meningitidis in cases with clinical invasive meningococcal disease. Most laboratory-based surveillance systems for meningococcal meningitis rely
Further characterization of N. meningitidis
An understanding of meningococcal epidemiology and the potential prevention of disease by vaccination requires knowledge beyond the capsular serogroup. N. meningitidis can be characterized using traditional serological methods [18] and newer molecular approaches[214].
A commonly used tool for molecular characterization of N. meningitidis is multilocus sequence typing (MLST), which is performed through DNA sequencing of portions of 7 housekeeping genes [19]. The rationale for focusing on
Mechanisms that contribute to dynamic nature of meningococcal epidemiology
N. meningitidis uses a variety of mechanisms to undergo antigenic variability, particularly in the face of natural or vaccine-induced immunity [214]. This antigenic variability occurs mainly through horizontal gene transfer, which allows the organism to acquire large DNA sequences. The meningococcus also uses gene conversion, which is autologous recombination and does not require the acquisition of DNA from another strain [61], [62]. N. meningitidis is also capable of varying its antigenic
United States
Much of our knowledge about the recent epidemiology of meningococcal disease in the United States comes from the Active Bacterial Core surveillance (ABCs) network, an active, population- and laboratory-based surveillance system for invasive disease caused by N. meningitidis and other pathogens [11]. ABCs is considered to be highly sensitive for culture-positive meningococcal disease. The total population under surveillance in 2007 was approximately 39.5 million, representing 13% of the U.S.
Acknowledgments
We thank Eliseu Waldman for his review of the manuscript.
This work was supported in part by a career development award to Dr. Harrison, National Institute of Allergy and Infectious Diseases (K24 AI52788). Dr. Trotter is funded by a Personal Award Scheme Post-Doctoral Award from the National Institute of Health Research (UK Department of Health). Conflict of interest statement: None declared. Financial disclosures: Dr. Harrison reports receiving consulting fees and honoraria from Wyeth, Sanofi
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