1. Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation
- Author
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Emmanuel Ghartey, Caelin C. Potts, Carl Kinkade, Vivian Doedeh, James Yarkeh, Youhn Konway, Adam C. Retchless, Jeremias Naiene, Tolbert Nyenswah, Maame Amo-Addae, Dedesco Gweh, Himiede W Wilson, Lawrence Larway, Ralph Jetoh, Arthur Chang, Nuha Mahmoud, Lawrence Gorwor, Umaru Bao, Annette Brima-Davis, George Dauda, Peter Clement, Jessica L. Waller, Roseline N George, Maxwell Freeman, John Doedeh, Mosoka Fallah, Melissa J. Whaley, Mardia Stone, Mark Korvayan, Jerry D. Thomas, Laurel T. Jenkins, Anne von Gottberg, Jeni Vuong, Jonas M. Winchell, LeAnne M. Fox, Geraldine George, Thomas Nagbe, Siafa Lombeh, Philemon Gonotee, John T. Redd, Josiah George, Sandeep J. Joseph, Suzanne Friesen, Anne Perrocheau, Henry Kohar, Yatta Vera Walker, George Tamatai, Kwuakuan Yealue, Muhamed Taha, Leleh W Gornor-Pewu, Xin Wang, Desmond E. Williams, Lucy A McNamara, Maureen H. Diaz, Miatta Zenabu Gbanya, Thomas Monger, Alex Gasasira, Olayinka Stephen, Patrick Hardy, Barbara E Mahon, Gulu Gwesa, Garrison Kerwillain, Victoria Katawera, Nathaniel Dovillie, Joseph Asamoah Frimpong, Harouna M Djingarey, E. Kainne Dokubo, Sylvester Toe, Dhamari Naidoo, Samson Q Wiah, Mulbah Reed, Ray R. Arthur, Kira Christian, Thomas Paasewe, Thomas A. Clark, Joshua G. Schier, George Senneh, Jaymin C. Patel, Fahn Taweh, Susanna Schmink, Samuel Smith, Serena Fuller, Catherine H Bozio, and Denise Roth Allen
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Genotype ,Attack rate ,Neisseria meningitidis, Serogroup C ,Meningitis, Meningococcal ,Meningococcal disease ,Disease cluster ,Disease Outbreaks ,03 medical and health sciences ,Young Adult ,Case fatality rate ,Epidemiology ,Medicine ,Humans ,Child ,Aged ,Aged, 80 and over ,Molecular Epidemiology ,business.industry ,Outbreak ,Middle Aged ,medicine.disease ,Liberia ,Virology ,Survival Analysis ,030104 developmental biology ,Infectious Diseases ,Female ,Metagenomics ,African meningitis belt ,Contact Tracing ,business ,Meningitis ,Multilocus Sequence Typing - Abstract
Summary Background On April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain. Methods We collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage. Findings 28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217. Interpretation This outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt. Funding US Global Health Security.
- Published
- 2018