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The importance of surveillance: Group W meningococcal disease outbreak response and control in England
Helen Campbell1, Shamez Ladhani2
1Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK helen.campbell@phe.gov.uk.
Abstract:
Invasive meningococcal disease (IMD) is associated with high morbidity and mortality. Recently, use of the quadrivalent MenACWY conjugate vaccines has increased with the emergence of a hypervirulent MenW:cc11 strain in certain parts of the world, especially South America. In England, MenW:cc11 IMD cases increased rapidly after 2009 and was responsible for 24% of all IMD cases in 2014/15 compared to <5% previously, leading to the emergency introduction of a national teenage MenACWY conjugate vaccine programme in August 2015. Unusually, MenW:cc11 cases have been described presenting with severe gastrointestinal symptoms, including abdominal pain and diarrhoea, followed by rapid clinical deterioration and death.
Insights
Invasive meningococcal disease (IMD) cases surged due to a hypervirulent MenW:cc11 strain, prompting a national teenage vaccine program. This strain uniquely presents with severe gastrointestinal symptoms and rapid deterioration.
Area of Science:
- Microbiology
- Epidemiology
- Vaccinology
Background:
- Invasive meningococcal disease (IMD) poses significant health risks globally.
- The emergence of a hypervirulent Neisseria meningitidis serogroup W strain (MenW:cc11) has been linked to increased IMD cases and mortality worldwide.
- This strain has shown a distinct propensity for severe gastrointestinal manifestations.
Purpose of the Study:
- To analyze the epidemiological impact of the MenW:cc11 strain on IMD incidence.
- To highlight the unusual clinical presentation of MenW:cc11 associated IMD.
- To provide context for the implementation of vaccination strategies.
Main Methods:
- Retrospective analysis of IMD surveillance data.
- Review of clinical case reports associated with MenW:cc11 infections.
- Monitoring of vaccine program impact.
Main Results:
- A rapid increase in MenW:cc11 IMD cases was observed in England post-2009, rising from <5% to 24% of total IMD cases by 2014/15.
- MenW:cc11 cases exhibited severe gastrointestinal symptoms, including abdominal pain and diarrhea, preceding rapid clinical decline.
- An emergency national teenage MenACWY conjugate vaccine program was initiated in August 2015.
Conclusions:
- The MenW:cc11 strain represents a significant public health threat due to its hypervirulence and unique clinical presentation.
- The rapid implementation of the MenACWY conjugate vaccine program in England was a direct response to the MenW:cc11 epidemic.
- Continued surveillance and vaccination are crucial for controlling IMD outbreaks.
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