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Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2019, there were 206 notifications of IMD. Of these, 202 were laboratory-confirmed cases analysed by the reference laboratories of the Australian National Neisseria Network (NNN). Of the 202 laboratory-confirmed cases of IMD, 167 were confirmed by bacterial culture and 35 by nucleic acid amplification testing, and all had the serogroup determined. Fine typing was available on 146 samples (146/202, 72%). Neisseria meningitidis serogroup B (MenB) infections accounted for 50.0% (101/202); MenW for 26.2% (53/202); MenY for 20.8% (42/202) and MenC for 3.0% of cases (6/202). Of the MenW cases, 88% were PorA antigen type P1.5,2, and 65% of these (24/37) were sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary peaks of IMD notifications in Australia in 2019 were observed in infants less than 1 year of age (36/202, 18%) and in adults aged 65 years or older (39/202, 19%). MenB infections predominated in those aged less than 5 years and those aged 15-19 years, whereas MenW and MenY infections predominated in those aged 45 years or more. All 167 IMD isolates were tested for antimicrobial susceptibility. One isolate out of these 167 (0.6%) was resistant to penicillin with an MIC ≥ 1mg/L; 154/167 isolates (92%) had decreased susceptibility to penicillin. All isolates were susceptible to ceftriaxone and ciprofloxacin, and one isolate was resistant to rifampicin., (© Commonwealth of Australia CC BY-NC-ND.)

In our country, meningococcal disease has a low endemic and high lethality, with epidemic out breaks; some of them of historical character, like the one happened during the first half of the last century. The action of a group of doctors, pioneers in clinical, research and teaching aspects, together with the health personnel that constituted their team, immersed in a successful public health policy, allowed to consolidate the necessary care of the sick child of this serious pathology, as well as many others, thus enabling the development of a structured and scientific proposal, in the light of the knowledge available at that time. Therefore, after 80 years, it is important to review the various clini cal, pathophysiological and therapeutic aspects, in addition to the hospital and social context, of this successful history of the Chilean public health system.

Meningococcal disease was first clinically characterised by Gaspard Vieusseux in 1805, and its causative agent was identified by Anton Weichselbaum in 1887, who named it Diplococcus intracellularis menigitidis. From the beginning, the disease was dreaded because of its epidemic nature, predilection for previously healthy children and adolescents, and high mortality. In the last decade of the 19th century, the concept of serum therapy for toxin-related bacterial diseases was identified. This concept was applied to meningococcal disease therapy, in an independent way, by Wilhelm Kolle, August von Wasserman, and Georg Jochmann in Germany, and Simon Flexner in the USA, resulting in the first successful approach for the treatment of meningococcal disease. During the first three decades of the 20th century, serum therapy was the standard treatment for meningococcal disease. With the advent of sulphamides first and then antibiotics, serum therapy was abandoned. The great challenges that infectious diseases medicine is facing and the awaiting menaces in the future in terms of increasing antibiotic resistance, emergence of new pathogens, and re-emergence of old ones without effective therapy, make passive immunotherapy a promising tool. Acknowledging the achievements of our predecessors might teach us some lessons to bring light to our future., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013-2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600-35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp and 7 used MenB-4C. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6-259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.

Background: Invasive bacterial diseases (IBD) are a serious cause of hospitalization, sequelae and mortality. Albeit a low incidence, an increase in cases due to H. influenzae was registered in the past 4 years and, in the Tuscany region, an excess of cases due to N. meningitidis since 2015 is alarming. The purpose of this study is to deepen the knowledge of IBD epidemiology in Tuscany with particular attention to temporal trends., Methods: Tuscan residents hospitalized for IBD from January 1st 2000 to March 18th 2016 were selected from the regional hospital discharge database based on ICD-9-CM codes. Age-specific and standardized hospitalization rates were calculated together with case-fatality rates (CFRs). A time-trend analysis was performed; whereas, prognostic factors of death were investigated through univariable and multivariable analyses., Results: The average standardized hospitalization rates for invasive meningococcal diseases (IMD), invasive pneumococcal diseases and invasive diseases due to H. influenzae from 2000 to 2016 were 0.6, 1.8, and 0.2 per 100,000, respectively. The average CFRs were 10.5%, 14.5% and 11.5% respectively with higher values in the elderly. Older age was significantly associated with higher risk of death from all IBD. A significant reduction in hospitalization rates for IMD was observed after meningococcal C conjugate vaccine introduction. The Annual Percentage Change (APC) was -13.5 (95% confidence interval (CI) -22.3; -3.5) in 2005-2013 but has risen since that period. Furthermore, a significant increasing trend of invasive diseases due to H. influenzae was observed from 2005 onwards in children 1-4 years old (APC 13.3; 95% CI 0; 28.3)., Conclusions: This study confirms changes in the epidemiology of invasive diseases due to H. influenzae and IMD. Furthermore, attention is called to the prevention of IBD in the elderly because of the age group's significantly higher rate of hospitalizations and deaths for all types of IBD.

In 2016, there were 243 laboratory-confirmed cases of invasive meningococcal disease analysed by the Australian National Neisseria Network. This number was the highest number of laboratory confirmed cases since 2008. Probable and laboratory confirmed invasive meningococcal disease (IMD) are notifiable in Australia, and there were 252 IMD cases notified to the National Notifiable Diseases Surveillance System in 2016, the highest number reported since 2010. Meningococcal serogrouping was able to be determined for 98% (237/243) of laboratory confirmed IMD cases. Serogroup B infections accounted for 87 cases (37%), the lowest number and proportion reported since inception of the Australian Meningococcal Surveillance Programme (AMSP) in 1997. In contrast, the number and proportion of serogroup W infections (44%, 107 cases) in 2016 was the highest since the AMSP began. In addition, the number and proportion of serogroup Y infections (16%, 40 cases) was also the highest recorded by the AMSP. Molecular typing results were available for 225 of the 243 IMD cases. Of the serogroup W IMD strains that were able to be genotyped, 92% (97/105) have the PorA antigen encoding gene type P1.5,2 and of these, 72% (70/97) were sequence type 11, the same type as the hypervirulent serogroup W strain that has been circulating in the UK and South America since 2009. The primary IMD age peak was observed in adults aged 45 years or more, whilst secondary disease peaks were observed in those aged less than 5 years, and in adolescents aged 15-19 years. Serogroup B infections predominated in the age groups less than 1 year and 20-24 years, whereas serogroup W infections predominated in those aged 45 years or more. For all other age groups, distribution of serogroup B and W infections was roughly equal. Of the IMD isolates tested for antimicrobial susceptibility, 6% (11/189) were resistant to penicillin, and decreased susceptibility to penicillin was observed in a further 90% (170/189) of isolates. One Men W isolate demonstrated an elevated minimum inhibitory concentration (MIC) to ceftriaxone (0.125mg/L), the highest reported in Australia. All isolates tested were susceptible to rifampicin and ciprofloxacin., (This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or by email to copyright@health.gov.au.)

During the first 12 months of an emergency meningococcal ACWY vaccination program for teenagers in England, coverage among persons who left school in 2015, the first cohort to be vaccinated, was 36.6%. There were 69% fewer group W meningococcal cases than predicted by trend analysis and no cases in vaccinated teenagers.

A range of vaccines is available for preventing life-threatening diseases caused by infection with Neisseria meningitidis (meningococcus, Men). Capsule polysaccharide (CPS)-conjugate vaccines are successful prophylactics for serogroup MenA, MenC, MenW and MenY infections, and outer membrane vesicle (OMV) vaccines have been used successfully for controlling clonal serogroup MenB infections. MenB vaccines based on recombinant proteins identified by reverse vaccinology (Bexsero™) and proteomics (Trumenba™) approaches have recently been licensed and Bexsero™ has been introduced into the UK infant immunisation programme. In this review, we chart the development of these licensed vaccines. In addition, we discuss the plethora of novel vaccinology approaches that have been applied to the meningococcus with varying success in pre-clinical studies, but which provide technological platforms for application to other pathogens. These strategies include modifying CPS, lipooligosaccharide and OMV; the use of recombinant proteins; structural vaccinology approaches of designing synthetic peptide/mimetope vaccines, DNA vaccines and engineered proteins; epitope presentation on biological and synthetic particles; through vaccination with live-attenuated pathogen(s), or with heterologous bacteria expressing vaccine antigens, or to competitive occupation of the nasopharyngeal niche by commensal bacterial spp. After close to a century of vaccine research, it is possible that meningococcal disease may be added, shortly, to the list of diseases to have been eradicated worldwide by rigorous vaccination campaigns., (© FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Since 2013, there has been an increase in the number of notified cases of invasive meningococcal disease (IMD) due to serogroup W (MenW) in Australia. In response to this observed increase, the Communicable Diseases Network Australia convened a working group in 2015 to collate and analyse the epidemiology of MenW disease nationally. Enhanced surveillance data collected by jurisdictions were collated and analysed, and whole genome sequencing (WGS) of MenW isolates assessed the genomic relatedness of strains between 2012 and 2015. This report describes that epidemiology. Since 2013, the incidence and proportion of MenW has increased in Australia, rising from an average of 2% of all IMD cases annually (range 0% to 5%) between 1991 and 2012; to 8% (12/149) of cases in 2013, 10% (17/169) in 2014, and 19% (34/182) in 2015. Victoria has been the main affected state, with 50% (17/34) of national cases in 2015. MenW has affected older populations, with a median age between 2003 and 2015 being 44 years. During this period, case fatality was 10.7% (17/159), 2.3 times higher than for all IMD serogroups combined (4.7%, 173/3720). There were 7 deaths due to MenW in 2015 (CFR 21%). WGS has found the majority of Australian isolates cluster within a group of W:P1.5,2:F1-1:ST11 isolates from the United Kingdom and South America, regions where rapid spread and endemic transmission has occurred since 2009. The recent increase in incidence of MenW in Australia is evolving and is being closely monitored. Lessons learned from the international experience will be important in informing the public health response.

In 2014 there were 165 laboratory-confirmed cases of invasive meningococcal disease analysed by the Australian National Neisseria Network. This number was higher than the number reported in 2013, but was the second lowest reported since inception of the Australian Meningococcal Surveillance Programme in 1994. Probable and laboratory confirmed invasive meningococcal disease (IMD) are notifiable in Australia, and there were 170 IMD cases notified to the National Notifiable Diseases Surveillance System (NNDSS) in 2014. This was also higher than in 2013, but was the second lowest number of IMD cases reported to the NNDSS. The meningococcal serogroup was determined for 161/165 (98%) of laboratory confirmed IMD cases. Of these, 80.1% (129 cases) were serogroup B infections; 1.9% (3 cases) were serogroup C infections; 9.9% (16 cases) were serogroup W135; and 8.1% (13 cases) were serogroup Y. Primary and secondary disease peaks were observed in those aged 4 years or less, and in adolescents (15-19 years) respectively. Serogroup B cases predominated in all jurisdictions and age groups, except for those aged 65 years or over, where serogroups Y and W135 combined predominated. The overall proportion and number of IMD caused by serogroup B was higher than in 2013, but has decreased from previous years. The number of cases of IMD caused by serogroup C was the lowest reported to date. The number of IMD cases caused by serogroup Y was similar to previous years, but the number of IMD cases caused serogroup W135 was higher than in 2013. The proportion of IMD cases caused by serogroups Y and W135 has increased in recent years, whilst the overall number of cases of IMD has decreased. Molecular typing was able to be performed on 106 of the 165 IMD cases. In 2014, the most common porA genotypes circulating in Australia were P1.7-2,4 and P1.22,14. All IMD isolates tested were susceptible to ceftriaxone and ciprofloxacin. There were 2 isolates that were resistant to rifampicin. Decreased susceptibility to penicillin was observed in 88% of isolates.

Meningococcal disease is a serious public health threat, especially during mass gatherings such as Hajj and Umrah which provide optimal conditions for disease transmission. The disease is caused by Neisseria meningitidis and transmitted mainly via asymptomatic carriers. A review of the literature on asymptomatic N. meningitidis carriage among Hajj and Umrah pilgrims and their household contacts was performed. Carriage studies reported carriage rates to be higher in Hajj pilgrims compared to Umrah pilgrims and that these events promote acquisition of carriage among pilgrims. With some outliers, most studies found carriage rates among pilgrims to be comparable to those in populations under non-epidemic settings. However, these results should be interpreted with caution, taking into account the limitations within the studies identified. A wide variety of N. meningitidis serogroups appear to be circulating among Hajj and Umrah pilgrims, with serogroups W135 and B being most prominent. Current Hajj and Umrah meningococcal disease preventative measures do not necessarily prevent carriage and transmission, which may result in local and international outbreaks among susceptible populations. Monitoring carriage states of visitors and local inhabitants in the Kingdom of Saudi Arabia, as well as the implementation of preventive measures that impact carriage, are warranted to reduce the risk of Hajj and Umrah-related meningococcal disease outbreaks., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Invasive meningococcal disease remains a rare infectious disease not only with high mortality but also with important morbidity. Until recently no universal vaccine existed against serogroup B, which explains most of the cases in settings like Europe. The objective of this study was to analyze the clinical course and sequelae of meningococcal disease in Spain., Methods: Retrospective review of all children younger than 15 years admitted to any of the 36 hospitals in the MENDICOS Spanish network (www.mendicos.org) with confirmed or probable invasive meningococcal disease in children between January 2008 and December 2013., Results: A total of 458 cases were identified across the country, most of them occurring in previously healthy children (91.5%; n = 419/458). Median (interquartile range) age was 1.7 (0.7 and 4.6) years, with 53.1% of the cases occurring in children younger than 2 years; 82.1% (n = 368) were laboratory confirmed cases; 95.2% (n = 256) of those serogrouped were serogroup B. The diagnosis was meningitis in 24.9% (n = 114) of the cases, sepsis in 37.1% (n = 170) and both in 38.0% (n = 174). Mean hospital length of stay was 11.6 (10.9) days; 79.2% (n = 354) of the patients required pediatric intensive care unit admission, with a mean pediatric intensive care unit stay of 3.9 (4.9) days; 3.5% (n = 16) died; 12.9% (n = 59) of the survivors were discharged with some kind of physical sequelae, mainly neurological (n = 23)., Conclusions: Serogroup B invasive meningococcal infection explains substantial morbidity and mortality in Spain, occurring mainly in infants. The recent availability of a vaccine against serogroup B may change this scenario. Given that the vast majority of the cases occur in otherwise healthy children, inclusion of the meningococcal B vaccine in the national immunization program should be carefully considered.

During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.

In 2012, there were 208 laboratory-confirmed cases of invasive meningococcal disease (IMD) analysed by the National Neisseria Network, and 222 cases notified to the National Notifiable Diseases Surveillance System, thus laboratory data were available for 93.7% of cases of IMD in Australia in 2012. Isolates of Neisseria meningitidis from 116 invasive cases of meningococcal disease were available for testing, and the phenotype (serogroup, serotype and serosubtype) and/or genotype, and antibiotic susceptibility were determined. Molecular typing was performed for the 92 cases confirmed by nucleic acid amplification testing (NAAT). Typing information was available for 194 of the 208 laboratory confirmed cases and 83% (161 cases) were serogroup B infections, 5.7% (11 cases) were serogroup C infections, 3.6% (11 cases) were serogroup W135, and 7.7% (15 cases) were serogroup Y meningococci. The number of laboratory confirmed IMD cases in 2012 was the lowest since laboratory surveillance data have been reported. Primary and secondary disease peaks were observed in those aged 4 years or less and in adolescents (15-19 years) and young adults (20-24 years), respectively. Serogroup B cases predominated in all age groups and jurisdictions. In 2012, the most common porA genotype circulating in Australia was P1.7-2,4. Serogroup C, W135 and Y cases were numerically low, similar to previous years. Decreased susceptibility to the penicillin group of antibiotics was observed in 81.9% of isolates, and 1 isolate exhibited resistance to penicillin. All isolates remained susceptible to ceftriaxone, ciprofloxacin and rifampicin., (This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.)

Meningococci have historically caused extensive illness among members of the United States military. Three successive meningococcal vaccine types were used from 1971 through 2010; overall disease incidence dropped by >90% during this period. During 2006-2010, disease incidence of 0.38 (cases per 100,000 person-years) among members of the US military was not significantly different from the incidence of 0.26 among the age-matched US general population. Of the 26 cases in the US military, 5 were fatal, 15 were vaccine failures (e.g., illness in a person who had been vaccinated), and 9 were caused by Neisseria meningitidis serogroup Y. Incidences among 17- to 19-year-old basic trainees and among US Marines were significantly higher than among comparison military populations (p<0.05). No apparent change in epidemiology of meningococcal disease was observed after replacement of quadrivalent polysaccharide vaccine with conjugate vaccine in 2007. The data demonstrate that vaccination with meningococcal vaccine is effective.

In 2001 a significant proportion of cases of meningococcal meningitis toward the end of a serogroup A epidemic in Niger and Burkina Faso was found to be caused by serogroup W135 meningococci. The World Health Organization put in place in several African countries an extended surveillance scheme in preparation for a possible epidemic situation. In January 2002, the first large epidemic of meningococcal disease caused by serogroup W135 started in Burkina Faso, resulting in more than 12,000 cases and 1400 deaths. We report here the results of the laboratory-based surveillance and the characteristics of the epidemic clone.

Trends in meningococcal disease (MD) over the 20th century in Australia, as in other industrialised countries, have been characterised by epidemics during the two World Wars, a transient rise in incidence in the 1950s followed by endemic disease, and in the 1980s the emergence of a sustained hypersporadic phase. Epidemics occur at times of social upheaval and among marginalised populations, and resolve when living conditions improve. Periodic serogroup A epidemics have been replaced since the 1950s by endemic disease caused mainly by serogroups B and C meningococci. The current hypersporadic plateau in Australia, as in other industrialised countries, is associated with the intercontinental spread of hypervirulent clones of meningococci. The conjugate serogroup C vaccine has reduced the incidence of MD and carriage rates of serogroup C meningococci. However, the vaccine is expensive and its long-term impact on the emergence of non-vaccine strains and on nasopharyngeal microecology is unknown. A rising incidence of MD should not be viewed as the action of a virulent microbe exploiting a vulnerable population, but as the emergence of an "accidental pathogen" from an evolving host-microbial ecology. While it is essential to monitor the impact of vaccines on this ecology, we must find ways that can optimise our coexistence with microbes.

The epidemiology of meningococcal infections that arose in England and Wales during the period 1912-1983 has been reviewed. The outcome of meningococcal disease was dramatically improved when treatment with sulphonamides was introduced. With the emergence of sulphonamide-resistant strains, penicillin has become the drug of choice. Despite modern treatment, however, the mortality ratio during the last 30 years has remained about the same. Prompt diagnosis as well as immediate and effective treatment are cardinal needs. Even so, when infection is overwhelming there is little chance of saving the patient. Immunisation is probably the only effective answer but as yet there is not an effective vaccine to prevent group B infections which predominate in this country.