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Active surveillance of meningococcal meningitis in Poland
S Tyski1, W Grzybowska, I Lind
1Department of Antibiotics and Microbiology, Drug Institute, Warsaw, Poland.
Abstract:
Starting from 1970, the notification of N. meningitidis cases in Poland was compulsory and separated from other cases of meningitis purulenta. Based on the experience of European Monitoring Group on Meningococci, the active surveillance of meningococcal meningitis in Poland was initiated in April 1995. It was the first time that such study was conducted to recognise the actual situation of meningococcal meningitis infections in our country. Ninety seven N. meningitidis strains were isolated (31 in 1995 and 66 in 1996) from cerebrospinal fluid (CSF) of meningitis patients hospitalized in 54 hospitals located in 33 out of 49 provinces of Poland. Most patients were below 2 years of age and 43% belonged to infant group. Meningococcal strains were phenotypically characterized as follow: identification of N. meningitidis was performed by Gram staining, oxidase and catalase tests as well as latex or diagnostic sera agglutination assays. Meningococcal serotypes and subtypes were determined by whole-cell ELISA with monoclonal antibodies. The predominant meningococcal serogroup during 1995 and 1996 was B (80% of all isolates tested), the serogroup C (12.6%) and W-135 (3.5%). Only two non-groupable and two serogroup A strains were isolated in Poland. Active surveillance allowed to determine B:22:P1.14 to be the most prevalent N. meningitidis phenotype in Poland. Two isolates of N. meningitidis phenotype C:2a:P1.2,5, which caused emergency situation in Czech Republic since 1993, were isolated from CSF of patients in October 1996 in southern Poland. All strains were susceptible to cefotaxime, chloramphenicol, ciprofloxacin, rifampin and tetracycline; some strains were resistant to sulphonamides (60.6% - MIC = 32 mg/l and 14.8% - MIC = 128 mg/l). Only one of the tested strains in two years surveillance study in Poland was resistant to penicillin (MIC = 2 mg/l).
Insights
Active surveillance of meningococcal meningitis in Poland from 1995-1996 identified serogroup B as predominant. The study characterized Neisseria meningitidis strains, finding B:22:P1.14 as the most common phenotype.
Area of Science:
- Microbiology
- Epidemiology
- Infectious Diseases
Background:
- Compulsory notification of Neisseria meningitidis (N. meningitidis) cases in Poland began in 1970.
- Active surveillance for meningococcal meningitis was initiated in April 1995, marking the first comprehensive study of its kind in Poland.
Purpose of the Study:
- To determine the actual situation of meningococcal meningitis infections in Poland.
- To phenotypically characterize isolated N. meningitidis strains, including serogroup, serotype, and subtype.
- To assess antimicrobial susceptibility patterns of the isolated strains.
Main Methods:
- Isolation of N. meningitidis strains from cerebrospinal fluid (CSF) of hospitalized meningitis patients.
- Phenotypic characterization using Gram staining, oxidase, catalase tests, and latex/diagnostic sera agglutination.
- Serotyping and subtyping via whole-cell ELISA with monoclonal antibodies.
- Antimicrobial susceptibility testing, including Minimum Inhibitory Concentration (MIC) for specific antibiotics.
Main Results:
- Ninety-seven N. meningitidis strains were isolated between 1995 and 1996.
- Serogroup B was predominant (80%), followed by serogroup C (12.6%) and W-135 (3.5%).
- The most prevalent phenotype identified was B:22:P1.14.
- All strains were susceptible to cefotaxime, chloramphenicol, ciprofloxacin, rifampin, and tetracycline.
- High resistance to sulphonamides was observed (60.6% - MIC = 32 mg/l, 14.8% - MIC = 128 mg/l).
- Only one strain showed resistance to penicillin.
Conclusions:
- Active surveillance provided crucial insights into meningococcal meningitis epidemiology in Poland.
- Serogroup B strains, particularly the B:22:P1.14 phenotype, were the primary cause of infections during the study period.
- While generally susceptible to key antibiotics, resistance to sulphonamides highlights the need for ongoing monitoring of antimicrobial resistance patterns.