1. Household transmission of Neisseria meningitidis in the African meningitis belt: a longitudinal cohort study
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Kadidja Gamougam, Doumagoum Moto Dauglaz, Ibrahim Habiboulaye, Awa Traore, Sani Ousmane, Jean Pierre Gami, Thomas A. Clark, Leonard W. Mayer, Uma Onwuchekwa, Mahamadou Keita, Jacques Toralta, Aldiouma Diallo, Peter Wontuo, Eleanor R. Watkins, Arouna Woukeu, Martin C. J. Maiden, Boubou Tamboura, Daniel Chandramohan, Jean-Marc Collard, Kanny Diallo, Alemayehu Worku, Musa Hassan-King, Lawrence Yamuah, Ibrahim Dan Dano, Yenenesh K. Tekletsion, Abraham Hodgson, Isaac Osei, Rahamatou Moustapha Boukary, Bassira Issaka, Dorothea M. C. Hill, Lodoum Mbainadji, Abudulai Adams Forgor, Jules F. Gomis, Tesfaye Moti Demissie, Ahmed Bedru Omer, Galadima Gadzama, Xilian Bai, Assane Ndiaye, Abdoulaye Berthe, Stephen Laryea Quaye, Hubert Bassene, Akalifa Bugri, Maria Claudia Nascimento, Olivier Manigart, Jean-François Trape, Aliou Toure, Samba O. Sow, Omeiza Beida, Marietou Dieng, James M. Stuart, Nicole E. Basta, Thomas Irving, Odile B. Harrison, Sambo Zailani, Maxime Narbé, Babatunji A. Omotara, Brian Greenwood, Ray Borrow, Issoufa Rabe, Andromachi Karachaliou, Adama Coulibaly, Haimanot Guebre Xabher, Souleymane Doucoure, Cheikh Sokhna, Serge Alavo, Helen Findlow, Julia S. Bennett, Tsehaynesh Lema, Caroline Trotter, Abraham Aseffa, Shuaibu Yahya, Lisa S. Rebbetts, John W Williams, Jean-François Jusot, Oumer Ali, Mary Amodu, Nathan Naibei, Centre de Recherche Médicale et Sanitaire (Niamey, Niger) (CERMES), Réseau International des Instituts Pasteur (RIIP), Bill & Melinda Gates Foundation, Wellcome Trust., and MenAfriCar consortium : Armauer Hansen Research Institute, Addis Ababa, Ethiopia—Oumer Ali, Abraham Aseffa (principal investigator), Ahmed Bedru Omer, Tsehaynesh Lema, Tesfaye Moti Demissie, Yenenesh Tekletsion, Alemayehu Worku, Haimanot Guebre Xabher (deceased), Lawrence Yamuah. Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger (Member of the International Network of Pasteur Institutes)—Rahamatou Moustapha Boukary, Jean-Marc Collard (principal investigater), Ibrahim Dan Dano, Ibrahim Habiboulaye, Bassira Issaka, Jean-François Jusot, Sani Ousmane, Issoufa Rabe. Centre de Support en Santé International (CSSI), N'Djamena, Chad—Doumagoum Moto Daugla (principal investigater), Jean Pierre Gami, Kadidja Gamougam, Lodoum Mbainadji, Nathan Naibei, Maxime Narbé, Jacques Toralta. Centre pour les Vaccins en Développement, Bamako, Mali—Abdoulaye Berthe, Kanny Diallo, Mahamadou Keita, Adama Coulibaly, Uma Onwuchekwa, Samba O Sow (principal investigater), Boubou Tamboura, Awa Traore, Aliou Toure. Centers for Disease Control, Atlanta, GA, USA—Tom Clark, Leonard Mayer. Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria—Mary Amodu, Omeiza Beida, Galadima Gadzama, Babatunji Omotara (principal investigater), Sambo Zailani, Shuaibu Yahya. Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK—Daniel Chandramohan, Brian M Greenwood (principal investigater), Musa Hassan-King, Olivier Manigart, Maria Nascimento, James M Stuart, Arouna Woukeu. School of Public Health, University of Minnesota, Minneapolis, MN, USA—Nicole E Basta. Public Health England Vaccine Evaluation Unit, Manchester, UK—Xilian Bai, Ray Borrow, Helen Findlow. Institut de Recherche pour le Développement, Dakar, Senegal—Serge Alavo, Hubert Bassene, Aldiouma Diallo (principal investigater), Marietou Dieng, Souleymane Doucouré, Jules François Gomis, Assane Ndiaye, Cheikh Sokhna, Jean François Trape. Navrongo Health Research Centre, Navrongo, Ghana— Akalifa Bugri (deceased), Abudulai Forgor (deceased), Abraham Hodgson (principal investigater), Isaac Osei, Stephen L Quaye, John Williams, Peter Wontuo. University of Bristol, UK—Thomas Irving. University of Cambridge, UK—Caroline L Trotter, Andromachi Karachaliou. University of Oxford, UK—Julia Bennett, Dorothea Hill, Odile Harrison, Martin C Maiden, Lisa Rebbetts, Eleanor Watkins.
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Background information ,Pediatrics ,medicine.medical_specialty ,030231 tropical medicine ,MESH: Africa ,medicine.disease_cause ,MESH: Neisseria meningitidis ,Acquisition rate ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,MESH: Cross-Sectional Studies ,law ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,MESH: Child ,MESH: Family Characteristics ,Medicine ,030212 general & internal medicine ,Longitudinal cohort ,MESH: Longitudinal Studies ,Short duration ,MESH: Cohort Studies ,MESH: Adolescent ,MESH: Age Factors ,MESH: Humans ,business.industry ,Neisseria meningitidis ,MESH: Child, Preschool ,MESH: Infant, Newborn ,MESH: Meningitis, Meningococcal ,MESH: Adult ,General Medicine ,MESH: Infant ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,MESH: Male ,3. Good health ,Carriage ,Transmission (mechanics) ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,African meningitis belt ,business ,MESH: Carrier State ,MESH: Female ,Demography - Abstract
Summary Background Information on transmission of meningococcal infection in the African meningitis belt is scarce. We aimed to describe transmission patterns of Neisseria meningitidis (meningococcus) in households in the African meningitis belt. Methods Cross-sectional carriage surveys were done in seven African meningitis belt countries (Chad, Ethiopia, Ghana, Mali, Niger, Nigeria, and Senegal) between Aug 1, 2010, and Oct 15, 2012. Meningococcal carriers identified in these surveys and all available people in their households were recruited into this longitudinal cohort study. We took pharyngeal swabs at first visit and took further swabs twice a month for 2 months and then monthly for a further 4 months. We used conventional bacteriological and molecular techniques to identify and characterise meningococci. We estimated the rates of carriage acquisition and recovery using a multi-state Markov model. Findings Meningococci were isolated from 241 (25%) of 980 members of 133 households in which a carrier had been identified in the cross-sectional survey or at the first household visit. Carriage was detected subsequently in another household member who was not an index carrier in 75 households. Transmission within a household, suggested by detection of a further carrier with the same strain as the index carrier, was found in 52 of these 75 households. Children younger than 5 years were the group that most frequently acquired carriage from other household members. The overall individual acquisition rate was 2·4% (95% CI 1·6–4·0) per month, varying by age and household carriage status. The mean duration of carriage was 3·4 months (95% CI 2·7–4·4). Interpretation In the African meningitis belt, transmission of meningococci within households is important, particularly for young children, and periods of carriage are usually of short duration. Funding Bill & Melinda Gates Foundation, Wellcome Trust.
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