Outbreaks Open Access
Like 0


In 2015, a suspected cluster of two invasive meningococcal disease (IMD) cases of serogroup W (MenW) occurred in elderly care home residents in England over 7 months; case investigations followed United Kingdom guidance. An incident control team reviewed epidemiological information. Phenotyping of case specimens informed public health action, including vaccination and throat swabs to assess carriage. Whole genome sequencing (WGS) was conducted on case and carrier isolates. Conventional phenotyping did not exclude a microbiological link between cases (case 1 W:2a:P1.5,2 and case 2 W:2a:NT). After the second case, 33/40 residents and 13/32 staff were vaccinated and 19/40 residents and 13/32 staff submitted throat swabs. Two MenW carriers and two MenC carriers were detected. WGS showed that MenW case and carrier isolates were closely related and possibly constituted a locally circulating strain. Meningococcal carriage, transmission dynamics and influence of care settings on IMD in older adults are poorly understood. WGS analyses performed following public health action helped to confirm the close relatedness of the case and circulating isolates despite phenotypic differences and supported actions taken. WGS was not sufficiently timely to guide public health practice.


Article metrics loading...

Loading full text...

Full text loading...



  1. Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, et al. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Rev Vaccines. 2019;18(1):15-30.  https://doi.org/10.1080/14760584.2019.1557520  PMID: 30526162 
  2. Public Health England (PHE). Invasive meningococcal disease in England: annual report for 2017 to 2018 supplementary data tables. London: PHE; 2018. Available from: https://www.gov.uk/government/publications/meningococcal-disease-laboratory-confirmed-cases-in-england-and-wales
  3. Campbell H, Saliba V, Borrow R, Ramsay M, Ladhani SN. Targeted vaccination of teenagers following continued rapid endemic expansion of a single meningococcal group W clone (sequence type 11 clonal complex), United Kingdom 2015. Euro Surveill. 2015;20(28):21188.  https://doi.org/10.2807/1560-7917.ES2015.20.28.21188  PMID: 26212140 
  4. Office for National Statistics (ONS). Population Estimates for UK, England and Wales, Scotland and Northern Ireland: mid-2001 to mid 2010 and mid 2012 to mid-2016. Newport/Titchfield/London: ONS; [accessed 22 Mar 2018]. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationestimatesforukenglandandwalesscotlandandnorthernireland
  5. Public Health England (PHE). Continuing increase in meningococcal group W (MenW) disease in England. Health Protection Report. London: PHE; 2015. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/409070/hpr0715_pge_d.pdf
  6. Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, et al. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2015;60(4):578-85.  https://doi.org/10.1093/cid/ciu881  PMID: 25389259 
  7. Borrow R, Abad R, Trotter C, van der Klis FR, Vazquez JA. Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine. 2013;31(41):4477-86.  https://doi.org/10.1016/j.vaccine.2013.07.083  PMID: 23933336 
  8. Mayer LW, Reeves MW, Al-Hamdan N, Sacchi CT, Taha MK, Ajello GW, et al. Outbreak of W135 meningococcal disease in 2000: not emergence of a new W135 strain but clonal expansion within the electophoretic type-37 complex. J Infect Dis. 2002;185(11):1596-605.  https://doi.org/10.1086/340414  PMID: 12023765 
  9. Njanpop-Lafourcade BM, Parent du Châtelet I, Sanou O, Alonso JM, Taha MK. The establishment of Neisseria meningitidis serogroup W135 of the clonal complex ET-37/ST-11 as an epidemic clone and the persistence of serogroup A isolates in Burkina Faso. Microbes Infect. 2005;7(4):645-9.  https://doi.org/10.1016/j.micinf.2005.01.003  PMID: 15823512 
  10. Maiden MC, Bygraves JA, Feil E, Morelli G, Russell JE, Urwin R, et al. Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms. Proc Natl Acad Sci USA. 1998;95(6):3140-5.  https://doi.org/10.1073/pnas.95.6.3140  PMID: 9501229 
  11. Bratcher HB, Corton C, Jolley KA, Parkhill J, Maiden MCJ. A gene-by-gene population genomics platform: de novo assembly, annotation and genealogical analysis of 108 representative Neisseria meningitidis genomes. BMC Genomics. 2014;15(1):1138.  https://doi.org/10.1186/1471-2164-15-1138  PMID: 25523208 
  12. Lucidarme J, Hill DMC, Bratcher HB, Gray SJ, du Plessis M, Tsang RSW, et al. Genomic resolution of an aggressive, widespread, diverse and expanding meningococcal serogroup B, C and W lineage. J Infect. 2015;71(5):544-52.  https://doi.org/10.1016/j.jinf.2015.07.007  PMID: 26226598 
  13. Lucidarme J, Scott KJ, Ure R, Smith A, Lindsay D, Stenmark B, et al. An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup W strain, Scotland and Sweden, July to August 2015. Euro Surveill. 2016;21(45):30395.  https://doi.org/10.2807/1560-7917.ES.2016.21.45.30395  PMID: 27918265 
  14. Booy R, Gentile A, Nissen M, Whelan J, Abitbol V. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother. 2019;15(2):470-80.  https://doi.org/10.1080/21645515.2018.1532248  PMID: 30296197 
  15. Tsang RSW, Ahmad T, Tyler S, Lefebvre B, Deeks SL, Gilca R, et al. Whole genome typing of the recently emerged Canadian serogroup W Neisseria meningitidis sequence type 11 clonal complex isolates associated with invasive meningococcal disease. Int J Infect Dis. 2018;69:55-62.  https://doi.org/10.1016/j.ijid.2018.01.019  PMID: 29414677 
  16. Health Protection Agency (HPA). Guidance for the public health management of meningococcal disease in the UK. London: HPA; 2012. Available from: https://webarchive.nationalarchives.gov.uk/20170207134452/https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management
  17. Chatt C, Gajraj R, Hawker J, Neal K, Tahir M, Lawrence M, et al. Four-month outbreak of invasive meningococcal disease caused by a rare serogroup B strain, identified through the use of molecular PorA subtyping, England, 2013. Euro Surveill. 2014;19(44):20949.  https://doi.org/10.2807/1560-7917.ES2014.19.44.20949  PMID: 25394258 
  18. Meningitis Research Foundation (MRF). MRF Meningococcus Genome Library (MGL). [Accessed 24 Feb 2016 and 20 Mar 2019]. Available from: http://www.meningitis.org/research/genome
  19. Gray SJ, Trotter CL, Ramsay ME, Guiver M, Fox AJ, Borrow R, et al. , Meningococcal Reference Unit. Epidemiology of meningococcal disease in England and Wales 1993/94 to 2003/04: contribution and experiences of the Meningococcal Reference Unit. J Med Microbiol. 2006;55(Pt 7):887-96.  https://doi.org/10.1099/jmm.0.46288-0  PMID: 16772416 
  20. Zerbino DR, Birney E. Velvet: algorithms for de novo short read assembly using de Bruijn graphs. Genome Res. 2008;18(5):821-9.  https://doi.org/10.1101/gr.074492.107  PMID: 18349386 
  21. Zerbino DR. Using the Velvet de novo assembler for short-read sequencing technologies. Curr Protoc Bioinformatics. 2010;Chapter 11:5. PMID: 20836074 
  22. Jolley KA, Bray JE, Maiden MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124.  https://doi.org/10.12688/wellcomeopenres.14826.1  PMID: 30345391 
  23. Meningitis Research Foundation (MRF) Meningococcus Genome Library. (PubMLST) [Accessed 31 May 2019]. Available from https://pubmlst.org/bigsdb?db=pubmlst_neisseria_mrfgenomes
  24. Drijkoningen JJ, Rohde GG. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect. 2014;20(Suppl 5):45-51.  https://doi.org/10.1111/1469-0691.12461  PMID: 24313448 
  25. National Institute for Health and Care Excellence (NICE). Pneumonia in adults: diagnosis and management Clinical guideline [CG191]. London: NICE; 2014. Available from: https://www.nice.org.uk/guidance/CG191
  26. Trotter CL, Gay NJ, Edmunds WJ. The natural history of meningococcal carriage and disease. Epidemiol Infect. 2006;134(3):556-66.  https://doi.org/10.1017/S0950268805005339  PMID: 16238823 
  27. Bidmos FA, Neal KR, Oldfield NJ, Turner DPJ, Ala’Aldeen DAA, Bayliss CD. Persistence, replacement, and rapid clonal expansion of meningococcal carriage isolates in a 2008 university student cohort. J Clin Microbiol. 2011;49(2):506-12.  https://doi.org/10.1128/JCM.01322-10  PMID: 21123536 
  28. Ibarz-Pavón AB, Maclennan J, Andrews NJ, Gray SJ, Urwin R, Clarke SC, et al. Changes in serogroup and genotype prevalence among carried meningococci in the United Kingdom during vaccine implementation. J Infect Dis. 2011;204(7):1046-53.  https://doi.org/10.1093/infdis/jir466  PMID: 21881120 
  29. Caugant DA, Maiden MCJ. Meningococcal carriage and disease--population biology and evolution. Vaccine. 2009;27(Suppl 2):B64-70.  https://doi.org/10.1016/j.vaccine.2009.04.061  PMID: 19464092 
  30. Ladhani SN, Cordery R, Mandal S, Christensen H, Campbell H, Borrow R, et al. , PHE VaPIBI Forum Members. Preventing secondary cases of invasive meningococcal capsular group B (MenB) disease using a recently-licensed, multi-component, protein-based vaccine (Bexsero(®)). J Infect. 2014;69(5):470-80.  https://doi.org/10.1016/j.jinf.2014.07.002  PMID: 25043395 
  31. Public Health England (PHE). Meningococcal: the green book, chapter 22. Meningococcal immunisation information for public health professionals. Immunisation against infectious disease. London: PHE; 2016. Available from: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
  32. Public Health England (PHE). Guidance for the public health management of meningococcal disease in the UK Updated February 2018. London: PHE; 2018. Available from: https://www.gov.uk/government/collections/meningococcal-disease-guidance-data-and-analysis
  33. Krone M, Gray S, Abad R, Skoczyńska A, Stefanelli P, van der Ende A, et al. Increase of invasive meningococcal serogroup W disease in Europe, 2013 to 2017. Euro Surveill. 2019;24(14):1800245.  https://doi.org/10.2807/1560-7917.ES.2019.24.14.1800245  PMID: 30968827 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error