TY - JOUR
T1 - The Clinical Picture and Severity of Invasive Meningococcal Disease Serogroup W Compared With Other Serogroups in the Netherlands, 2015-2018
AU - Loenenbach, Anna D.
AU - van der Ende, Arie
AU - de Melker, Hester E.
AU - Sanders, Elisabeth A. M.
AU - Knol, Mirjam J.
N1 - Funding Information: Acknowledgments. The authors thank Anneke Westerhof from the National Institute for Public Health and the Environment (RIVM) for data management within the Dutch Invasive Meningococcal Disease surveillance system. Furthermore, they acknowledge the work of the laboratory personnel of the Netherlands Reference Laboratory for Bacterial Meningitis. This publication made use of the Neisseria Multi Locus Sequence Typing website (https://pubmlst.org/neisseria/) developed by Keith Jolley and sited at the University of Oxford [43]. The development of this site was funded by the Wellcome Trust and the European Union. The authors gratefully acknowledge the contributions of Lisa Hansen and her useful and constructive suggestions on this paper. Funding Information: Financial support. This work was funded by the National Institute of Public Health, the Netherlands. Publisher Copyright: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/5/6
Y1 - 2020/5/6
N2 - Background. An increase in invasive meningococcal disease (IMD) serogroup W (IMD-W) cases caused by sequence type-11 clonal complex (cc11) was observed from October 2015 in the Netherlands. We compared the clinical picture and disease outcome of IMD-W cases with other serogroups, adjusting for host characteristics. Methods. We included IMD cases reported from January 2015 to June 2018 in the Netherlands and assessed clinical manifestation and symptoms at disease onset and calculated case fatality rates (CFRs). We used logistic regression to compare clinical manifestations and mortality of IMD-W with IMD caused by meningococci serogroup B, Y, or C, adjusting for age, gender, and comorbidities. Results. A total of 565 IMD cases were reported, of which 204 were IMD-W, 270 IMD-B, 63 IMD-Y, and 26 IMD-C. Most IMD-W isolates belonged to cc11 (93%; 175/188). Compared with other serogroups, IMD-W patients were diagnosed more often with septicemia (46%) or pneumonia (12%) and less often with meningitis (17%, P <.001). IMD-W cases presented more often with respiratory symptoms (45%, P <.001); 16% of IMD-W patients presented with diarrhea without IMD-specific symptoms (P =.061). The CFR for IMD-W was 16% (32/199, P <.001). The differences between IMD-W and other serogroups remained after adjusting for age, gender, and comorbidities. Conclusions. The atypical presentation and severe outcome among IMD-W cases could not be explained by age, gender, and comorbidities. Almost all our IMD-W cases were caused by cc11. More research is needed to identify the bacterial factors involved in clinical presentation and severity of IMD-W cc11.
AB - Background. An increase in invasive meningococcal disease (IMD) serogroup W (IMD-W) cases caused by sequence type-11 clonal complex (cc11) was observed from October 2015 in the Netherlands. We compared the clinical picture and disease outcome of IMD-W cases with other serogroups, adjusting for host characteristics. Methods. We included IMD cases reported from January 2015 to June 2018 in the Netherlands and assessed clinical manifestation and symptoms at disease onset and calculated case fatality rates (CFRs). We used logistic regression to compare clinical manifestations and mortality of IMD-W with IMD caused by meningococci serogroup B, Y, or C, adjusting for age, gender, and comorbidities. Results. A total of 565 IMD cases were reported, of which 204 were IMD-W, 270 IMD-B, 63 IMD-Y, and 26 IMD-C. Most IMD-W isolates belonged to cc11 (93%; 175/188). Compared with other serogroups, IMD-W patients were diagnosed more often with septicemia (46%) or pneumonia (12%) and less often with meningitis (17%, P <.001). IMD-W cases presented more often with respiratory symptoms (45%, P <.001); 16% of IMD-W patients presented with diarrhea without IMD-specific symptoms (P =.061). The CFR for IMD-W was 16% (32/199, P <.001). The differences between IMD-W and other serogroups remained after adjusting for age, gender, and comorbidities. Conclusions. The atypical presentation and severe outcome among IMD-W cases could not be explained by age, gender, and comorbidities. Almost all our IMD-W cases were caused by cc11. More research is needed to identify the bacterial factors involved in clinical presentation and severity of IMD-W cc11.
KW - Meningococcal infections
KW - Neisseria meningitidis
KW - Netherlands
KW - Public health surveillance
KW - Serogroup W
UR - http://www.scopus.com/inward/record.url?scp=85084272717&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciz578
DO - https://doi.org/10.1093/cid/ciz578
M3 - Article
C2 - 31556938
SN - 1058-4838
VL - 70
SP - 2036
EP - 2044
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -