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Outbreaks Open Access
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Abstract

In Italy, serogroup C meningococci of the clonal complex cc11 (MenC/cc11) have caused several outbreaks of invasive meningococcal disease (IMD) during the past 20 years. Between December 2019 and January 2020, an outbreak of six cases of IMD infected with MenC/cc11 was identified in a limited area in the northern part of Italy. All cases presented a severe clinical picture, and two of them were fatal. This report is focused on the microbiological and molecular analysis of meningococcal isolates with the aim to reconstruct the chain of transmission. It further presents the vaccination strategy adopted to control the outbreak. The phylogenetic evaluation demonstrated the close genetic proximity between the strain involved in this outbreak and a strain responsible for a larger epidemic that had occurred in 2015 and 2016 in the Tuscany Region. The rapid identification and characterisation of IMD cases and an extensive vaccination campaign contributed to the successful control of this outbreak caused by a hyperinvasive meningococcal strain.

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/content/10.2807/1560-7917.ES.2022.27.24.2100919
2022-06-16
2022-08-07
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.24.2100919
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References

  1. Peterson ME, Li Y, Bita A, Moureau A, Nair H, Kyaw MH, et al. Meningococcal serogroups and surveillance: a systematic review and survey. J Glob Health. 2019;9(1):010409.  https://doi.org/10.7189/jogh.09.010409  PMID: 30603079 
  2. Lucidarme J, Hill DM, Bratcher HB, Gray SJ, du Plessis M, Tsang RS, 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 
  3. Waśko I, Hryniewicz W, Skoczyńska A. Significance of meningococcal hyperinvasive clonal complexes and their influence on vaccines development. Pol J Microbiol. 2015;64(4):313-21.  https://doi.org/10.5604/17331331.1185912  PMID: 26999951 
  4. Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med. 2001;344(18):1378-88.  https://doi.org/10.1056/NEJM200105033441807  PMID: 11333996 
  5. Ezeoke I, Galac MR, Lin Y, Liem AT, Roth PA, Kilianski A, et al. Tracking a serial killer: Integrating phylogenetic relationships, epidemiology, and geography for two invasive meningococcal disease outbreaks. PLoS One. 2018;13(11):e0202615.  https://doi.org/10.1371/journal.pone.0202615  PMID: 30485280 
  6. Ladhani SN, Lucidarme J, Parikh SR, Campbell H, Borrow R, Ramsay ME. Meningococcal disease and sexual transmission: urogenital and anorectal infections and invasive disease due to Neisseria meningitidis. Lancet. 2020;395(10240):1865-77.  https://doi.org/10.1016/S0140-6736(20)30913-2  PMID: 32534649 
  7. Taha MK, Claus H, Lappann M, Veyrier FJ, Otto A, Becher D, et al. Evolutionary events associated with an outbreak of meningococcal disease in men who have sex with men. PLoS One. 2016;11(5):e0154047.  https://doi.org/10.1371/journal.pone.0154047  PMID: 27167067 
  8. De Schrijver K, Maes I. An outbreak of serogroup C meningococcal disease in the province of Antwerp (Belgium) in 2001-2002. Eur J Epidemiol. 2003;18(11):1073-7.  https://doi.org/10.1023/A:1026100321871  PMID: 14620942 
  9. Miglietta A, Fazio C, Neri A, Pezzotti P, Innocenti F, Azzari C, et al. Interconnected clusters of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11), involving bisexuals and men who have sex with men, with discos and gay-venues hotspots of transmission, Tuscany, Italy, 2015 to 2016. Euro Surveill. 2018;23(34):1700636.  https://doi.org/10.2807/1560-7917.ES.2018.23.34.1700636  PMID: 30153883 
  10. Italian National Health Institute (Istituto Superiore di Sanità, ISS). Sorveglianza delle malattie batteriche invasive in Italia. Rapporto consolidato MIB 2019 . [Surveillance data on invasive bacterial diseases, consolidated report 2019]. Rome: ISS; 2020. Italian. Abvailable from: https://www.iss.it/-/rapporto-consolidato-mib-2019
  11. Fazio C, Neri A, Tonino S, Carannante A, Caporali MG, Salmaso S, et al. Characterisation of Neisseria meningitidis C strains causing two clusters in the north of Italy in 2007 and 2008. Euro Surveill. 2009;14(16):19179.  https://doi.org/10.2807/ese.14.16.19179-en  PMID: 19389338 
  12. Stefanelli P, Fazio C, Neri A, Isola P, Sani S, Marelli P, et al. Cluster of invasive Neisseria meningitidis infections on a cruise ship, Italy, October 2012. Euro Surveill. 2012;17(50):20336.  https://doi.org/10.2807/ese.17.50.20336-en  PMID: 23241233 
  13. Stefanelli P, Fazio C, Vacca P, Palmieri A, Ambrosio L, Neri A, et al. An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11. Clin Microbiol Infect. 2019;25(1):111.e1-4.  https://doi.org/10.1016/j.cmi.2018.07.014  PMID: 30036673 
  14. European Centre for Disease Prevention and Control (ECDC). Field epidemiology manual wiki. Outbreak investigations. Stockholm: ECDC. [Accessed: 26 May 2022]. Available from: https://wiki.ecdc.europa.eu/fem/Pages/Outbreak%20Investigations.aspx
  15. Zhu H, Wang Q, Wen L, Xu J, Shao Z, Chen M, et al. Development of a multiplex PCR assay for detection and genogrouping of Neisseria meningitidis. J Clin Microbiol. 2012;50(1):46-51.  https://doi.org/10.1128/JCM.00918-11  PMID: 22090406 
  16. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 12.0, 2022. Växjö: EUCAST. Available from: http://www.eucast.org/clinical_breakpoints
  17. 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 
  18. Jolley KA, Brehony C, Maiden MCJ. Molecular typing of meningococci: recommendations for target choice and nomenclature. FEMS Microbiol Rev. 2007;31(1):89-96.  https://doi.org/10.1111/j.1574-6976.2006.00057.x  PMID: 17168996 
  19. Stefanelli P, Fazio C, Neri A, Ciammaruconi A, Balocchini E, Anselmo A, et al. Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11. J Infect. 2016;73(2):136-44.  https://doi.org/10.1016/j.jinf.2016.05.003  PMID: 27235364 
  20. Andrews S. FastQC. A quality control tool for high throughput sequence data. Cambridge: Babraham Institute; 2010.
  21. Joshi NA, Fass JN. Sickle: A sliding-window, adaptive, quality-based trimming tool for FastQ files using quality (Version 1.33). 2011. Available from https://github.com/najoshi/sickle
  22. Simpson JT, Wong K, Jackman SD, Schein JE, Jones SJ, Birol I. ABySS: a parallel assembler for short read sequence data. Genome Res. 2009;19(6):1117-23.  https://doi.org/10.1101/gr.089532.108  PMID: 19251739 
  23. Jolley KA, Maiden MC. BIGSdb: Scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics. 2010;11(1):595.  https://doi.org/10.1186/1471-2105-11-595  PMID: 21143983 
  24. Bratcher HB, Corton C, Jolley KA, Parkhill J, Maiden MC. 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 
  25. Huson DH, Bryant D. Application of phylogenetic networks in evolutionary studies. Mol Biol Evol. 2006;23(2):254-67.  https://doi.org/10.1093/molbev/msj030  PMID: 16221896 
  26. Ministero della Salute. Piano Nazionale Prevenzione Vaccinale PNPV 2017-2019. [National plan for vaccine prevention NPVP 2017-2019]. Rome: Ministero della Salute; 2017. Italian. Available from: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf
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