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Internal Medicine (Tokyo, Japan) 2016We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups... (Review)
Review
We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides. N. meningitidis, also called meningococcus, is a Gram-negative, aerobic, diplococcus bacterium. The various consequences of severe meningococcal sepsis include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC. The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid. Blood, CSF, and skin biopsy cultures are used for diagnosis. Meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care. Management of the systemic circulation, respiration, and intracranial pressure is vital for improving the prognosis, which has dramatically improved since the wide availability of antibiotics. This review of the literature provides an overview of current concepts on meningococcemia due to N. meningitidis infection.
Topics: Adult; Africa; Anti-Bacterial Agents; Cephalosporins; Child; Chloramphenicol; Disease Outbreaks; Disseminated Intravascular Coagulation; Drug Resistance, Bacterial; Host-Pathogen Interactions; Humans; Meningococcal Infections; Neisseria meningitidis; Osteonecrosis; Penicillin G; Sepsis; Vaccines, Conjugate
PubMed: 26984070
DOI: 10.2169/internalmedicine.55.3272 -
Human Vaccines & Immunotherapeutics May 2018Meningococcal disease continues to be a life threatening infection with high morbidity and mortality even in appropriately treated patients. Meningococcal vaccination... (Review)
Review
Meningococcal disease continues to be a life threatening infection with high morbidity and mortality even in appropriately treated patients. Meningococcal vaccination plays a major role in the control of the disease; however, implementing vaccination remains problematic in the developing world. The objective of this review is to identify the challenges facing the use of meningococcal vaccines in the developing world in order to discuss the opportunities and available solutions to improve immunization in these countries. Inadequate epidemiologic information necessary to implement vaccination and financial challenges predominate. Multiple measures are needed to achieve the successful implementation of meningococcal conjugate vaccination programs that protect against circulating serogroups in developing countries including enhanced surveillance systems, financial support and aid through grants, product development partnerships that are the end result of effective collaboration and communication between different interdependent stakeholders to develop affordable vaccines, and demonstration of the cost-effectiveness of new meningococcal vaccines.
Topics: Cost of Illness; Cost-Benefit Analysis; Developing Countries; Epidemiological Monitoring; Humans; Immunization Programs; Incidence; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; Serogroup; Vaccination
PubMed: 29393729
DOI: 10.1080/21645515.2018.1434463 -
Virulence Jan 2014Despite considerable advances in the understanding of the pathogenesis of meningococcal disease, this infection remains a major cause of morbidity and mortality... (Review)
Review
Despite considerable advances in the understanding of the pathogenesis of meningococcal disease, this infection remains a major cause of morbidity and mortality globally. The role of the complement system in innate immune defenses against invasive meningococcal disease is well established. Individuals deficient in components of the alternative and terminal complement pathways are highly predisposed to invasive, often recurrent meningococcal infections. Genome-wide analysis studies also point to a central role for complement in disease pathogenesis. Here we review the pathophysiologic events pertinent to the complement system that accompany meningococcal sepsis in humans. Meningococci use several often redundant mechanisms to evade killing by human complement. Capsular polysaccharide and lipooligosaccharide glycan composition play critical roles in complement evasion. Some of the newly described protein vaccine antigens interact with complement components and have sparked considerable research interest.
Topics: Antibodies, Bacterial; Antigens, Bacterial; Bacterial Capsules; Complement Activation; Complement C4b-Binding Protein; Complement Factor H; Humans; Immunity, Innate; Lipopolysaccharides; Meningococcal Infections; Neisseria meningitidis; Sepsis; Vitronectin
PubMed: 24104403
DOI: 10.4161/viru.26515 -
Human Vaccines & Immunotherapeutics 2019Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is characterized by high mortality and morbidity. While IMD incidence peaks in both infants and... (Review)
Review
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is characterized by high mortality and morbidity. While IMD incidence peaks in both infants and adolescents/young adults, carriage rates are often highest in the latter age groups, increasing IMD risk and the likelihood of transmission. Effective vaccines are available for 5 of 6 disease-causing serogroups. Because adolescents/young adults represent a significant proportion of cases, often have the highest carriage rate, and have characteristically low vaccination adherence, efforts should be focused on educating this population regarding long-term consequences of infection and the importance of meningococcal vaccination in prevention. This review describes the role of adolescents/young adults in meningococcal transmission and the clinical consequences and characteristics of IMD in this population. With a focus on countries with advanced economies that have specific meningococcal vaccination recommendations, the epidemiology of meningococcal disease and vaccination recommendations in adolescents/young adults will also be discussed.
Topics: Adolescent; Humans; Incidence; Meningococcal Infections; Meningococcal Vaccines; Serogroup; Vaccination; Young Adult
PubMed: 30273506
DOI: 10.1080/21645515.2018.1528831 -
The Cochrane Database of Systematic... Oct 2013Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the disease during the first week of a case being detected. Prophylaxis is considered for close contacts of people with a meningococcal infection and populations with known high carriage rates.
OBJECTIVES
To study the effectiveness, adverse events and development of drug resistance of different antibiotics as prophylactic treatment regimens for meningococcal infection.
SEARCH METHODS
We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to June week 1, 2013), EMBASE (1980 to June 2013) and LILACS (1982 to June 2013).
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-RCTs addressing the effectiveness of different antibiotics for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis.
DATA COLLECTION AND ANALYSIS
Two review authors independently appraised the quality and extracted data from the included trials. We analysed dichotomous data by calculating the risk ratio (RR) and 95% confidence interval (CI) for each trial.
MAIN RESULTS
No new trials were found for inclusion in this update. We included 24 studies; 19 including 2531 randomised participants and five including 4354 cluster-randomised participants. There were no cases of meningococcal disease during follow-up in the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed.Mortality that was reported in one study was not related to meningococcal disease or treatment. Ciprofloxacin (RR 0.04; 95% CI 0.01 to 0.12), rifampin (rifampicin) (RR 0.17; 95% CI 0.13 to 0.24), minocycline (RR 0.28; 95% CI 0.21 to 0.37) and penicillin (RR 0.47; 95% CI 0.24 to 0.94) proved effective at eradicating N. meningitidis one week after treatment when compared with placebo. Rifampin (RR 0.20; 95% CI 0.14 to 0.29), ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) and penicillin (RR 0.63; 95% CI 0.51 to 0.79) still proved effective at one to two weeks. Rifampin was effective compared to placebo up to four weeks after treatment but resistant isolates were seen following prophylactic treatment. No trials evaluated ceftriaxone against placebo but rifampin was less effective than ceftriaxone after one to two weeks of follow-up (RR 5.93; 95% CI 1.22 to 28.68). Mild adverse events associated with treatment were observed.
AUTHORS' CONCLUSIONS
Using rifampin during an outbreak may lead to the circulation of resistant isolates. Use of ciprofloxacin, ceftriaxone or penicillin should be considered. All four agents were effective for up to two weeks follow-up, though more trials comparing the effectiveness of these agents for eradicating N. meningitidis would provide important insights.
Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Humans; Meningococcal Infections; Minocycline; Neisseria meningitidis; Randomized Controlled Trials as Topic; Rifampin
PubMed: 24163051
DOI: 10.1002/14651858.CD004785.pub5 -
Human Vaccines & Immunotherapeutics Jun 2020
Topics: Humans; Meningitis, Meningococcal; Meningococcal Infections; Meningococcal Vaccines; Vaccines, Conjugate
PubMed: 32598245
DOI: 10.1080/21645515.2020.1752558 -
Epidemiology and Infection Oct 2016The Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with recognized expertise in meningococcal disease including... (Review)
Review
The Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with recognized expertise in meningococcal disease including microbiology, immunology, epidemiology, public health and vaccinology. The GMI was established to promote the global prevention of meningococcal disease through education, research and international cooperation. The GMI held its second summit meeting in 2013 to discuss the different aspects of existing meningococcal immunization programmes and surveillance systems. Laboratory confirmation and characterization were identified as essential for informing evidence-based vaccine implementation decisions. The relative merits of different confirmatory methodologies and their applications in different resource settings were a key component of the discussions. This paper summarizes the salient issues discussed, with special emphasis on the recommendations made and any deficiencies that were identified.
Topics: Guidelines as Topic; Humans; Meningococcal Infections; Public Health
PubMed: 27357022
DOI: 10.1017/S0950268816001308 -
The Journal of Infection Mar 2022This review article incorporates information from the 4th Global Meningococcal Initiative summit meeting. Since the introduction of stringent COVID-19 infection control... (Review)
Review
This review article incorporates information from the 4th Global Meningococcal Initiative summit meeting. Since the introduction of stringent COVID-19 infection control and lockdown measures globally in 2020, there has been an impact on IMD prevalence, surveillance, and vaccination compliance. Incidence rates and associated mortality fell across various regions during 2020. A reduction in vaccine uptake during 2020 remains a concern globally. In addition, several Neisseria meningitidis clonal complexes, particularly CC4821 and CC11, continue to exhibit resistance to antibiotics, with resistance to ciprofloxacin or beta-lactams mainly linked to modifications of gyrA or penA alleles, respectively. Beta-lactamase acquisition was also reported through horizontal gene transfer (bla) involving other bacterial species. Despite the challenges over the past year, progress has also been made on meningococcal vaccine development, with several pentavalent (serogroups ABCWY and ACWYX) vaccines currently being studied in late-stage clinical trial programmes.
Topics: COVID-19; Communicable Disease Control; Humans; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; SARS-CoV-2; Serogroup
PubMed: 34838594
DOI: 10.1016/j.jinf.2021.11.016 -
International Journal of Environmental... Mar 2022Meningococcal disease is caused by ; 13 serogroups have been identified and differentiated from each other through their capsular polysaccharide. Serotypes A, B, C, W,...
Meningococcal disease is caused by ; 13 serogroups have been identified and differentiated from each other through their capsular polysaccharide. Serotypes A, B, C, W, X, and Y are responsible for nearly all infections worldwide. The most common clinical manifestations are meningitis and invasive meningococcal disease, both characterized by high mortality and long-term sequelae. The infection rate is higher in children younger than 1 year and in adolescents, who are frequently asymptomatic carriers. Vaccination is the most effective method of preventing infection and transmission. Currently, both monovalent meningococcal vaccines (against A, B, and C serotypes) and quadrivalent meningococcal vaccines (against serogroups ACYW) are available and recommended according to local epidemiology. The purpose of this article is to describe the meningococcal vaccines and to identify instruments that are useful for reducing transmission and implementing the vaccination coverage. This aim could be reached by switching from the monovalent to the quadrivalent vaccine in the first year of life, increasing vaccine promotion against ACYW serotypes among adolescents, and extending the free offer of the anti-meningococcal B vaccine to teens, co-administering it with others proposed in the same age group. Greater awareness of the severity of the disease and increased health education through web and social networks could represent the best strategies for promoting adhesion and active participation in the vaccination campaign. Finally, the development of a licensed universal meningococcal vaccine should be another important objective.
Topics: Adolescent; Child; Humans; Immunization Programs; Meningitis, Meningococcal; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; Vaccination; Vaccines, Conjugate
PubMed: 35409716
DOI: 10.3390/ijerph19074035 -
Human Vaccines & Immunotherapeutics Jun 2013Meningococcal disease remains a devastating and feared infection with a significant morbidity and mortality profile. The successful impact of meningococcal capsular... (Review)
Review
Meningococcal disease remains a devastating and feared infection with a significant morbidity and mortality profile. The successful impact of meningococcal capsular group C glyconconjugate vaccines introduced into the UK infant immunization schedule in 1999, has resulted in >80% of disease now being attributable to meningococcal capsular group B (MenB). MenB glyconconjugate vaccines are not immunogenic and hence, vaccine design has focused on sub-capsular antigens. Recently, a four component vaccine to combat MenB disease (4CMenB) has progressed through clinical development and was approved by the European Medicines Agency at the end of 2012. This vaccine has proven safe and immunogenic and has been predicted to provide protection against ~73% of the MenB disease from England and Wales. Recommendation/implementation of the vaccine into the UK infant schedule is currently being evaluated. 4CMenB has the potential to provide protection against a significant proportion of MenB disease in the UK which is currently unpreventable.
Topics: Clinical Trials as Topic; Drug Approval; Humans; Immunization Schedule; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis, Serogroup B; United Kingdom; Vaccines, Conjugate
PubMed: 23732894
DOI: 10.4161/hv.24689