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Recent emergence of serogroup C meningococcal disease in Greece
J Kremastinou1, G Tzanakaki, A Kansouzidou
1National Meningococcal Reference Laboratory, National School of Public Health, Athens, Greece.
Abstract:
The number of cases of meningococcal disease reported to the Meningitis Reference Laboratory in Athens rose dramatically in 1996-1997. The aims were (1) to determine if the increase was due to introduction of new strains, (2) to assess the geographic and age distribution of the cases, (3) to compare antibiotic sensitivity patterns of the current isolates with strains from the early 1990s. In 1993-1994, 15/19 (74%) of the cases for which information on age was available were in children < or = 5 years; in 1995-1997, 80/179 (45%) of cases were in children < or = 5 years and 99 (55%) in the older age range (P < 0.02). From 593 cases in 1993 1997, 214 (36%) isolates were available for characterisation. Serogroup B was predominant in the early 1990s, but by 1997, serogroup C accounted for 46/72 (64%) of isolates and serogroup B for 25/72 (35%). Serogroup B was predominant in children < or = 5 years (44/78, 56%) but only 19/99 (18%) of older children and adults (P=0.0000005). Sulfonamide resistance decreased from 10/22 (45%) in 1993-1994 to 27/192 (14%) in 1995-1997 (P<0.01). Multilocus enzyme electrophoresis of 70 strains obtained during this period identified the epidemic ET-15 clone in 24 (34.3)%. The profiles of the Greek ET-15 isolates were identical to C:2a:P1.2(P1.5) strains responsible for the epidemic in the Czech Republic which began in 1993. This genotype was not found in Greek strains isolated prior to 1993. We conclude that the increase in meningococcal disease is due to introduction of the epidemic serogroup C:2a:P1.2(P1.5) strain responsible for disease in the Czech Republic and Canada.
Insights
A surge in meningococcal disease in Greece was linked to the introduction of a new serogroup C strain, the ET-15 clone, originating from the Czech Republic. This epidemic strain shifted disease demographics towards older age groups.
Area of Science:
- Epidemiology
- Microbiology
- Public Health
Background:
- Meningococcal disease cases in Athens significantly increased during 1996-1997.
- Previous understanding of circulating strains and their characteristics was limited.
Purpose of the Study:
- To investigate the cause of the meningococcal disease outbreak in Greece.
- To analyze the geographic and age distribution of cases.
- To compare antibiotic resistance patterns of current isolates with historical strains.
Main Methods:
- Analysis of case data reported to the Meningitis Reference Laboratory.
- Characterization of bacterial isolates, including serogrouping and antibiotic sensitivity testing.
- Multilocus enzyme electrophoresis (MEE) for strain typing.
Main Results:
- A shift in predominant serogroups was observed, with serogroup C becoming dominant by 1997.
- The epidemic ET-15 clone (C:2a:P1.2(P1.5)) was identified in Greek isolates, identical to strains from the Czech Republic epidemic.
- Cases increasingly affected older age groups, unlike the earlier predominance in young children.
- Sulfonamide resistance in isolates decreased over the study period.
Conclusions:
- The rise in meningococcal disease was attributed to the introduction of the epidemic ET-15 clone.
- This strain, previously absent in Greece, is linked to outbreaks in the Czech Republic and Canada.
- The changing age distribution suggests the new strain impacts different populations.